Web-based intervention using behavioural activation and physical activity for adults with depression
By Emma Norris, on 19 November 2018
By Dr Jeff Lambert – University of Exeter, UK – on behalf of the eMotion study team.
Depression is on the rise and is linked to a range of chronic conditions such as cardiovascular disease, obesity and diabetes. In 2016, the NHS dispensed over 64 million antidepressant prescription items in England. Despite being effective for a substantial number of people, anti-depressants do not work for everyone, and do not tackle the physical health problems associated with depression. Physical activity has been shown to be just effective as antidepressants in treating depression and is also effective at treating and preventing chronic physical health problems. We therefore aimed to assess the feasibility and acceptability of a web-based intervention that combined an existing evidence based psychological therapy (behavioural activation) and physical activity promotion for people with depression (eMotion).
The eMotion intervention is an eight week web-based modular intervention which was based on the Behavioural Activation and Physical Activity (BAcPAc) intervention delivered through the Improving Access to Psychological Therapies (IAPT) service. The eMotion intervention was adapted from BAcPAc for use in an online context using the Centre for eHealth Research and Disease Management (CeHReS) roadmap. The CeHReS roadmap promotes active stakeholder involvement and helped to ensure that key user needs were being catered to along the developmental process. Using a systematic and graded approach, eMotion targets the behavioural avoidance, common in depression by encouraging daily activities, with an emphasis on physical activity. eMotion was developed using the Behaviour change techniques (BCTs) were used to describe the underlying framework of the intervention (click here for more information on the eMotion development process). BCTs were used from the Behaviour Change Techniques Taxonomy v1 (BCTTv1) including Graded tasks, Action Planning, and Goal setting.
In our pilot randomised controlled trial we recruited 62 people with elevated depressive symptoms from the community and randomised them to eMotion or a wait list control group for eight weeks. As this was a pilot study, we were primarily interested in recruitment, retention, intervention fidelity, acceptability of the intervention and data collection procedures. We also collected data for depression, anxiety using web-based self-report and physical activity levels using wrist worn accelerometers.
Our pilot study recruited well, had good retention and showed a reduction in symptoms of depression and anxiety in favour of the intervention group. We were underpowered to determine changes in physical activity (as it was a pilot) and fidelity data indicated that people only engaged with the website for a median of 41.3 minutes and accessed a median of three modules. However, low engagement in web-based interventions could either indicate disengagement or the development of sufficient mastery.
Now we know that eMotion is feasible, we are currently seeking funding to conduct a full scale trial to find out whether eMotion reduces depressive symptoms for adults in the community with depression.
You can find the results of the eMotion pilot randomised controlled trial here.
1) How can we best measure intervention engagement, over and above website usage?
2) What are the best ways of recruiting people with depression into web-based interventions?
Dr Jeff Lambert (@Jefflambert12) is currently a Postdoctoral Research Associate in Primary Care at the University of Exeter Medical School. Jeff completed a BSc in Psychology at the University of Winchester, an MSc in Health Psychology at the University of Southampton and has recently been awarded his PhD in Health and Wellbeing at the University of Exeter. Jeff’s research interests include physical activity, mental health, and behaviour change and intervention fidelity.