A randomised control trial of an Internet-based cognitive behaviour treatment for mood disorder in adults with chronic spinal cord injury

Study design: Prospective parallel waitlist randomised controlled trial. Objectives: Evaluate the feasibility and effectiveness of an Internet-based psychological intervention treating comorbid mood disorder in adults with spinal cord injury (SCI). Improved mood and satisfaction with life were primary outcomes. Setting: Victoria, Australia. Intervention: Electronic Personal Administration of Cognitive Therapy (ePACT). Measures: Depression, Anxiety and Stress Scale-Short Form (DASS21), Personal Well-being Index, Helplessness subscale of the Spinal Cord Lesion Emotional Well-being Scale v1 Australia, at each time point. Participant qualifying criteria: Adults (18-70 years), chronic SCI, attend SCI review clinic at Austin or Caulfield Hospital and score above normative threshold of the Depression, Anxiety and Stress Scale-Short Form (DASS21). Methods: Forty-eight participants completed Time 2 post intervention (n=23) or time equivalent for waitlist control group (n=25) telephone interviews. The measures were repeated a third time (Time 3) for a small subgroup (n=12) at 6 months post intervention within the study implementation time frame. Results: Univariate within group analyses revealed significant improvement in mood in the intervention group at Time 2: (lower depression (effect size (ES)=0.4), anxiety (ES=0.4) and stress (ES=0.3)) and higher satisfaction with life (ES=0.2). Waitlist control group improved in depression only (ES=0.3) by Time 2. Multilevel variance components analyses, although not as positive, were still encouraging. Improvement in mood symptoms was maintained in the small group reinter viewed at Time 3. Conclusion: Although Internet-based interventions for mental health issues in SCI not a solution for all, our results indicate that they are a potentially valuable addition to the currently available options.