Moodbuster (E-MODEL): The feasibility of digital cognitive behavioural therapy (CBT) for depressed older adults: Study protocol of two pilot feasibility studies (Preprint)

BACKGROUND Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce and little is known about their feasibility and effectiveness. OBJECTIVE To present the design of two studies aiming to assess the feasibility of internet-based cognitive behavioural treatment (CBT) for older adults with depression (E-MODEL). We will assess the feasibility of an online, guided version of E-MODEL among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in specialised mental health care outpatient clinic. METHODS A single-group pretest-posttest design will be applied for both settings. The primary outcome of the studies will be feasibility in terms of (a) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8, (b) usability (measured with the System Usability Scale) and (c) engagement (measured with the Twente Engagement with Ehealth Technologies Scale). Secondary outcomes include: (a) severity of depressive symptoms (PHQ-8), (b) participant and therapist experience with the digital technology (with the use of qualitative interviews), (c) working alliance between patient and practitioner (from both perspectives; WAI-SF), (d) technical alliance between patient and the platform (WAI-TECH-SF) and (e) uptake in terms of attemped and completed modules. N=30 older adults with mild to moderate depressive symptoms (score between 5 and 11 as measured with the Geriatric Depression Scale 15) will be recruited from the general population. N=15 older adults with moderate to severe depressive symptoms (GDS-15 score between 8 and 15) will be recruited from a specialised mental health care outpatient clinic. RESULTS A mixed-method approach of quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be additionally explored with an individual semistructured interview and synthesized descriptively. Descriptive statistics (Mean and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a two-tailed paired sample t-test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis. CONCLUSIONS The results of this pilot study will show whether this platform is feasible among the older adult population in a blended and guided format in the two settings as well as a first exploration of the size of the effect of E-MODEL in terms of decrease of depressive symptoms.