The Development and Initial Feasibility of a Cognitive-Behavioural Group Intervention for COVID-19-Related Anxiety and Depression
Main Article Content
Eamon Aswad
http://orcid.org/0000-0001-7692-7820
Keith Gaynor
http://orcid.org/0000-0003-2628-7858
http://orcid.org/0000-0001-7692-7820
Keith Gaynor
http://orcid.org/0000-0003-2628-7858
Abstract
Background: The COVID-19 pandemic resulted in adverse psychological outcomes for many people in the general public globally.
Aim: This paper discusses the development and initial feasibility testing of a novel manualised online group cognitive behavioural therapy intervention targeting the maintenance factors of COVID-19-related anxiety and depression. The paper is in two sections describing: (i) the development of the intervention and (ii) a pilot study examined initial acceptability and feasibility of the intervention.
Methods: Section 1 used the Six Steps in Quality Intervention Development methodology to systematically develop the intervention. Section 2 used a mixed-method design to assess feasibility and acceptability. The quantitative assessment examined uptake, completion, and pre–post intervention changes in psychological distress (N=8). A thematic analysis of qualitative interviews measured subjective acceptability.
Results: A theoretically coherent, novel intervention that did not replicate existing treatment designs was developed. Low levels of engagement in online data-gathering did not allow for an assessment of effectiveness. However, there was a high level of participant retention, and qualitative data highlighted a high level of treatment appropriateness, positive post-intervention change and acceptability for those who took part.
Conclusion: This initial feasibility study indicated that the intervention was feasible and acceptable and warranted further investigation.
Keywords:
Clinical Intervention, Group Telepsychology, Depression, Anxiety, CBT, Remote
Article Details
How to Cite
ASWAD, Eamon; GAYNOR, Keith.
The Development and Initial Feasibility of a Cognitive-Behavioural Group Intervention for COVID-19-Related Anxiety and Depression.
Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3669>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v11i7.1.3669.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Bueno-Notivol J, Gracia-García P, Olaya B, Lasheras I, López-Antón R, & Santabárbara J. Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies. Int J Clin Health Psychol. 2021; 21(1): 100196. doi: 10.1016/j.ijchp.2020.07.007
2. Plomecka MB, Gobbi S, Neckels R, Radziński P, Skórko B, Lazerri S, Jawaid A. Mental Health Impact of COVID-19: A global study of risk and resilience factors. MedRxiv. 2020; doi:10.1101/2020.05.05.20092023
3. Salehi M, Amanat M, Mohammadi M, Salmanian M, Rezaei N, Saghazadeh A, Garakani A.The prevalence of posttraumatic stress disorder related symptoms in Coronavirus outbreaks: a systematic review and meta-analysis. J Affect Disord. 2021; 282: 527–538. doi:10.1016/j.jad.2020.12.188
4. Santabárbara J, Lasheras I, Lipnicki DM, Bueno-Notivol J, Pérez-Moreno M, López-Antón R, Gracia-García P. Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. Prog Neuropsychopharmacol Biol Psychiatry. 2021; 109: 110207.
doi: 10.1016/j.pnpbp.2020.110207
5. Shevlin M, McBride O, Murphy J, Miller JG, Hartman TK, Levita L, Bentall RP. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open. 2020; 6(6): doi:10.1192/bjo.2020.109
6. Hyland P, Shevlin M, McBride O, Murphy J, Karatzias T, Bentall RP, Vallières F. Anxiety and depression in the Republic of Ireland during the COVID‐19 pandemic. Acta Psychiatr Scand. 2020; 142(3): 249-256. doi:10.1111/acps.13219
7. Central Statistics Office. Social Impact of COVID-19 Survey April. 2020; May 8: https://www.cso.ie/en/releasesandpublications/ep/p-sic19/socialimpactofcovid-19surveyapril2020/
8. Central Statistics Office. Social Impact of COVID-19 Survey August 2020: The Reopening of Schools. 2020; August 27: https://www.cso.ie/en/releasesandpublications/ep/p-sic19ros/socialimpactofcovid-19surveyaugust2020thereopeningofschools/
9. Central Statistics Office. Social Impact of COVID-19 Survey February 2021: Wellbeing. 2021: February 25: https://www.cso.ie/en/releasesandpublications/ep/p-sic19wbg/socialimpactofcovid-19surveyfebruary2021well-being/.
10. Central Statistics Office. Social Impact of COVID-19 Survey November 2020 Wellbeing and Lifestyle under Level 5 Restrictions. 2020; November 30. https://www.cso.ie/en/releasesandpublications/ep/psic19wbl5/socialimpactofcovid-19surveynovember2020well-beingandlifestyleunderlevel5restrictions
11. Karatzias, T., Shevlin, M., Murphy, J., McBride, O., Ben-Ezra, M., Bentall, R. P., Vallières, F., & Hyland, P. Posttraumatic stress symptoms and associated comorbidity during the COVID-19 pandemic in Ireland: A population-based study. J Trauma Stress. 2020; 33(4): 365–370. doi:10.1002/jts.22565
12. Wang M, Zhao Q, Hu C, Wang Y, Cao J, Huang S, Yang Y. Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study. J Affect Disord. 2021; 281: 312-320. doi:10.1016/j.jad.2020.11.118
13. Wight D, Wimbush E, Jepson R, Doi L. Six steps in quality intervention development (6SQuID). J Epidemiol Community Health. 2016; 70(5): 520–525. doi:10.1136/jech-2015-205952
14. Delz AK, Gaynor K, O'Connor R, Schmieder L, Somers E. A confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression. Acta Psychologica. 2023 Feb 9:103861. https://doi.org/10.1016/j.actpsy.2023.103861
15. Taylor S. COVID Stress Syndrome: Clinical and Nosological Considerations. Curr Psychiatry Rep. 2021; 23(4). doi:10.1007/s11920-021-01226-y
16. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson JG. Development and initial validation of the COVID Stress Scales. J Anx Disord. 2020: 72; 102232. doi:10.1016/j.janxdis.2020.102232
17. Lahav, Y. Psychological distress related to COVID-19–the contribution of continuous traumatic stress. J Affect Disord. 2020; 277: 129–137. doi:10.1177/1524838015585316
18. Nuttman-Shwartz O, Shoval-Zuckerman Y. Continuous traumatic situations in the face of ongoing political violence: The relationship between CTS and PTSD. Trauma, Violence, Abuse. 2016; 17(5): 562–570. doi:10.1177/1524838015585316
19. Stevens G, Eagle G, Kaminer D, Higson-Smith C. Continuous traumatic stress: Conceptual conversations in contexts of global conflict, violence and trauma. Peace Confl. 2013; 19(2): 75. https://doi.org/10.1037/a0032484
20. Beck AT, Haigh EA. Advances in cognitive theory and therapy: The generic cognitive model. Annu Rev Clin Psychol. 2014; 10: 1–24. doi:10.1146/annurev-clinpsy-032813-153734
21. Beck AT. The current state of cognitive therapy: a 40-year retrospective. Arch Gen Psychiatry. 2005; 62(9): 953–959. doi:10.1001/archpsyc.62.9.953
22. Kendall T, Cape J, Chan M, Taylor, C. Management of generalised anxiety disorder in adults: summary of NICE guidance. BMJ. 2011; 342. doi:10.1136/bmj.c7460
23. Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, Calati R. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020; 22(8): 1-22. doi:10.1007/s11920-020-01166-z
24. Smits JA, Julian K, Rosenfield D, Powers MB. Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: a systematic review. J Consult Clin Psychol. 2012;80(4), 624 –635. doi:10.1037/a0028957
25. Varker T, Brand RM, Ward J, Terhaag S, Phelps A. Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychol Serv. 2019; 16(4): 621 –635. doi:10.1037/ser0000239
26. Vazquez C, Valiente C, García FE, Contreras A, Peinado V, Trucharte A, Bentall RP. Posttraumatic growth and stress-related responses during the COVID-19 pandemic in a national representative sample: The role of positive core beliefs about the world and others. J Happiness Stud. 2021: 1-21. doi:10.1007/s10902-020-00352-3
27. Weinberg, H. (2020). Online group psychotherapy: Challenges and possibilities during COVID-19—A practice review. Group Dyn. 2020; 24(3), 201–211. doi:10.1037/gdn0000140
28. Gaynor K. Coping During Covid-19 Workbook. OSF Preprints. 2021; https://doi.org/10.31219/osf.io/ruaxy.
29. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009; 36(5): 452–457. https://doi.org/10.1016/j.amepre.2009.02.002
30. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017; 17(1). doi:10.1186/s12913-017-2031-8
31. Elliot R, Rodgers B. Client change interview schedule: Follow-up version (2008; v5). Retrieved June 10, 2019.
32. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2): 77–101. doi:10.1191/1478088706qp063oa
33. Gaynor K, Dooley B, Lawlor E, Lawoyin LR. Predicting Uptake of Group CBT in a First-Episode Psychosis Cohort. Cogn Behav Therap. 2014; 43(2), 105-110. doi: 10.1080/16506073.2013.858766.
34. Stoll J, Müller JA, Trachsel M. Ethical issues in online psychotherapy: A narrative review. Front Psychiatry. 2020; 10: 993. doi:10.3389/fpsyt.2019.00993
35. Inchausti F, MacBeth A, Hasson-Ohayon I, Dimaggio G. Psychological intervention and COVID-19: What we know so far and what we can do. J Contemp Psychother. 2020; 50: 243-250. doi:10.1007/s10879-020-09460-w
36. Solomonov N, Kanellopoulos D, Grosenick L, Wilkins V, Goldman R, Ritholtz S, Falk A, Gunning FM. CopeNYP: a brief remote psychological intervention reduces health care workers’ depression and anxiety symptoms during COVID-19 pandemic. World Psychiatry. 2022; 21: 155-156. https://doi.org/10.1002/wps.20946
37. Egan S, Shafran R, Wade T, Ure S, Gill C. Wilker L. Anderson R, Mazzucchelli T, McEvoy P. A qualitative examination of low-intensity cognitive behaviour therapy to reduce anxiety and depression during the COVID-19 pandemic, Clinical Psychologist. 2022; 26:2: 222-230, DOI: 10.1080/13284207.2022.2031946
2. Plomecka MB, Gobbi S, Neckels R, Radziński P, Skórko B, Lazerri S, Jawaid A. Mental Health Impact of COVID-19: A global study of risk and resilience factors. MedRxiv. 2020; doi:10.1101/2020.05.05.20092023
3. Salehi M, Amanat M, Mohammadi M, Salmanian M, Rezaei N, Saghazadeh A, Garakani A.The prevalence of posttraumatic stress disorder related symptoms in Coronavirus outbreaks: a systematic review and meta-analysis. J Affect Disord. 2021; 282: 527–538. doi:10.1016/j.jad.2020.12.188
4. Santabárbara J, Lasheras I, Lipnicki DM, Bueno-Notivol J, Pérez-Moreno M, López-Antón R, Gracia-García P. Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. Prog Neuropsychopharmacol Biol Psychiatry. 2021; 109: 110207.
doi: 10.1016/j.pnpbp.2020.110207
5. Shevlin M, McBride O, Murphy J, Miller JG, Hartman TK, Levita L, Bentall RP. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open. 2020; 6(6): doi:10.1192/bjo.2020.109
6. Hyland P, Shevlin M, McBride O, Murphy J, Karatzias T, Bentall RP, Vallières F. Anxiety and depression in the Republic of Ireland during the COVID‐19 pandemic. Acta Psychiatr Scand. 2020; 142(3): 249-256. doi:10.1111/acps.13219
7. Central Statistics Office. Social Impact of COVID-19 Survey April. 2020; May 8: https://www.cso.ie/en/releasesandpublications/ep/p-sic19/socialimpactofcovid-19surveyapril2020/
8. Central Statistics Office. Social Impact of COVID-19 Survey August 2020: The Reopening of Schools. 2020; August 27: https://www.cso.ie/en/releasesandpublications/ep/p-sic19ros/socialimpactofcovid-19surveyaugust2020thereopeningofschools/
9. Central Statistics Office. Social Impact of COVID-19 Survey February 2021: Wellbeing. 2021: February 25: https://www.cso.ie/en/releasesandpublications/ep/p-sic19wbg/socialimpactofcovid-19surveyfebruary2021well-being/.
10. Central Statistics Office. Social Impact of COVID-19 Survey November 2020 Wellbeing and Lifestyle under Level 5 Restrictions. 2020; November 30. https://www.cso.ie/en/releasesandpublications/ep/psic19wbl5/socialimpactofcovid-19surveynovember2020well-beingandlifestyleunderlevel5restrictions
11. Karatzias, T., Shevlin, M., Murphy, J., McBride, O., Ben-Ezra, M., Bentall, R. P., Vallières, F., & Hyland, P. Posttraumatic stress symptoms and associated comorbidity during the COVID-19 pandemic in Ireland: A population-based study. J Trauma Stress. 2020; 33(4): 365–370. doi:10.1002/jts.22565
12. Wang M, Zhao Q, Hu C, Wang Y, Cao J, Huang S, Yang Y. Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study. J Affect Disord. 2021; 281: 312-320. doi:10.1016/j.jad.2020.11.118
13. Wight D, Wimbush E, Jepson R, Doi L. Six steps in quality intervention development (6SQuID). J Epidemiol Community Health. 2016; 70(5): 520–525. doi:10.1136/jech-2015-205952
14. Delz AK, Gaynor K, O'Connor R, Schmieder L, Somers E. A confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression. Acta Psychologica. 2023 Feb 9:103861. https://doi.org/10.1016/j.actpsy.2023.103861
15. Taylor S. COVID Stress Syndrome: Clinical and Nosological Considerations. Curr Psychiatry Rep. 2021; 23(4). doi:10.1007/s11920-021-01226-y
16. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson JG. Development and initial validation of the COVID Stress Scales. J Anx Disord. 2020: 72; 102232. doi:10.1016/j.janxdis.2020.102232
17. Lahav, Y. Psychological distress related to COVID-19–the contribution of continuous traumatic stress. J Affect Disord. 2020; 277: 129–137. doi:10.1177/1524838015585316
18. Nuttman-Shwartz O, Shoval-Zuckerman Y. Continuous traumatic situations in the face of ongoing political violence: The relationship between CTS and PTSD. Trauma, Violence, Abuse. 2016; 17(5): 562–570. doi:10.1177/1524838015585316
19. Stevens G, Eagle G, Kaminer D, Higson-Smith C. Continuous traumatic stress: Conceptual conversations in contexts of global conflict, violence and trauma. Peace Confl. 2013; 19(2): 75. https://doi.org/10.1037/a0032484
20. Beck AT, Haigh EA. Advances in cognitive theory and therapy: The generic cognitive model. Annu Rev Clin Psychol. 2014; 10: 1–24. doi:10.1146/annurev-clinpsy-032813-153734
21. Beck AT. The current state of cognitive therapy: a 40-year retrospective. Arch Gen Psychiatry. 2005; 62(9): 953–959. doi:10.1001/archpsyc.62.9.953
22. Kendall T, Cape J, Chan M, Taylor, C. Management of generalised anxiety disorder in adults: summary of NICE guidance. BMJ. 2011; 342. doi:10.1136/bmj.c7460
23. Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, Calati R. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020; 22(8): 1-22. doi:10.1007/s11920-020-01166-z
24. Smits JA, Julian K, Rosenfield D, Powers MB. Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: a systematic review. J Consult Clin Psychol. 2012;80(4), 624 –635. doi:10.1037/a0028957
25. Varker T, Brand RM, Ward J, Terhaag S, Phelps A. Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychol Serv. 2019; 16(4): 621 –635. doi:10.1037/ser0000239
26. Vazquez C, Valiente C, García FE, Contreras A, Peinado V, Trucharte A, Bentall RP. Posttraumatic growth and stress-related responses during the COVID-19 pandemic in a national representative sample: The role of positive core beliefs about the world and others. J Happiness Stud. 2021: 1-21. doi:10.1007/s10902-020-00352-3
27. Weinberg, H. (2020). Online group psychotherapy: Challenges and possibilities during COVID-19—A practice review. Group Dyn. 2020; 24(3), 201–211. doi:10.1037/gdn0000140
28. Gaynor K. Coping During Covid-19 Workbook. OSF Preprints. 2021; https://doi.org/10.31219/osf.io/ruaxy.
29. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009; 36(5): 452–457. https://doi.org/10.1016/j.amepre.2009.02.002
30. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017; 17(1). doi:10.1186/s12913-017-2031-8
31. Elliot R, Rodgers B. Client change interview schedule: Follow-up version (2008; v5). Retrieved June 10, 2019.
32. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2): 77–101. doi:10.1191/1478088706qp063oa
33. Gaynor K, Dooley B, Lawlor E, Lawoyin LR. Predicting Uptake of Group CBT in a First-Episode Psychosis Cohort. Cogn Behav Therap. 2014; 43(2), 105-110. doi: 10.1080/16506073.2013.858766.
34. Stoll J, Müller JA, Trachsel M. Ethical issues in online psychotherapy: A narrative review. Front Psychiatry. 2020; 10: 993. doi:10.3389/fpsyt.2019.00993
35. Inchausti F, MacBeth A, Hasson-Ohayon I, Dimaggio G. Psychological intervention and COVID-19: What we know so far and what we can do. J Contemp Psychother. 2020; 50: 243-250. doi:10.1007/s10879-020-09460-w
36. Solomonov N, Kanellopoulos D, Grosenick L, Wilkins V, Goldman R, Ritholtz S, Falk A, Gunning FM. CopeNYP: a brief remote psychological intervention reduces health care workers’ depression and anxiety symptoms during COVID-19 pandemic. World Psychiatry. 2022; 21: 155-156. https://doi.org/10.1002/wps.20946
37. Egan S, Shafran R, Wade T, Ure S, Gill C. Wilker L. Anderson R, Mazzucchelli T, McEvoy P. A qualitative examination of low-intensity cognitive behaviour therapy to reduce anxiety and depression during the COVID-19 pandemic, Clinical Psychologist. 2022; 26:2: 222-230, DOI: 10.1080/13284207.2022.2031946