CRUfADclinic.org: Where People Get Well. Andrews G. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. CRUfADclinic.org:
where people get well
Gavin Andrews AO MD
Clinical Research Unit for Anxiety and
Depression (CRUfAD),
UNSW at St Vincent‟s Hospital, Sydney,
Australia.
CRUfADclinic is a not for profit initiative of St Vincent‟s Hospital

2. Depressive & Anxiety Disorders
• 7% of the burden of human disease
• Greater than diabetes + asthma + arthritis
• Principal cause of disability in the world
• Not well treated by SSRIs or FtF CBT

3. Systematic review
Andrews, Cuijpers, Craske, McEvoy, Titov.
• iCBT or cCBT versus control group
• diagnosed cases of
• major depression,
• social phobia,
• panic disorder,
• GAD.
• 22 Randomized Controlled Trials
• Research quality good
• Follow up duration ~6mo
• Patient adherence and satisfaction high

4. Study name Statistics for each study
Hedges's Lower Upper
g limit limit Z-Value p-Value
Andersson, 2005 0,87 0,43 1,32 3,83 0,00
Kessler, 2009 0,61 0,33 0,88 4,30 0,00
Perini, 2009 0,56 -0,05 1,17 1,81 0,07
Selmi, 1990 1,26 0,40 2,11 2,89 0,00
Titov, 2010 0,99 0,55 1,44 4,36 0,00
Wright, 2005 1,10 0,35 1,85 2,87 0,00
0,78 0,59 0,96 8,20 0,00
Carlbring, 2001 0,97 0,33 1,61 2,99 0,00
Carlbring, 2006 1,13 0,59 1,66 4,10 0,00
Klein, 2001 0,39 -0,41 1,18 0,95 0,34
Klein, 2006 1,49 0,77 2,20 4,07 0,00
Richards, 2006 0,74 -0,12 1,60 1,69 0,09
Wims, 2009 0,28 -0,25 0,81 1,03 0,30
0,83 0,45 1,21 4,27 0,00
Andersson, 2006 0,76 0,26 1,26 2,97 0,00
Berger, 2009 0,64 0,08 1,20 2,23 0,03
Botella, 2009 1,07 0,50 1,64 3,66 0,00
Carlbring, 2007 1,07 0,52 1,61 3,81 0,00
Furmark, 2009 0,67 0,22 1,11 2,92 0,00
Titov, 2008 I 0,94 0,53 1,36 4,48 0,00
Titov, 2008 II 1,18 0,71 1,65 4,95 0,00
Titov, 2008 III 1,02 0,51 1,53 3,91 0,00
0,92 0,74 1,09 10,28 0,00
Robinson, 2009 1,13 0,70 1,56 5,16 0,00
Titov, 2009 1,08 0,46 1,69 3,41 0,00
1,11 0,76 1,47 6,19 0,00
0,88 0,76 0,99 15,04 0,00
-2,00 -1,00 0,00 1,00 2,00

5. Results are amazing: NNT~2
Andrews, Cuijpers, Craske, McEvoy, Titov.
Disorder N of trials Hedges g NNT
Depression 6 0.78 2.4
Social Phobia 8 0.92 2.1
Panic 6 0.83 2.3
Disorder
GAD 2 1.12 1.8
All Studies 22 0.88 2.2

6. In Sydney, Australia
• National TV assessed the course for depression
• www.ABC.net.au/Catalyst [virtualclinic]

8. Efficacy: virtualclinic.org.au
14 Trials: depression=3, social phobia=7, panic=2, GAD=2
• Patients as severe as patients in our face to face specialist clinic
• make the same or better progress (mean ES=0.9)
• progress is better at the six month follow up.
• little clinician time involved, (practice nurses spend 40 minutes).
• 80% of people complete their course, say they are satisfied,
Internet therapy in these four disorders is effective, efficient
and acceptable to the patient.

9. Depression: ¾ recover (Completers n=66)
PHQ-9 PHQ-9 PHQ-9 PHQ-9
None Mild Moderate Severe
(0-9) (10-14) (15-19) (20-27)
Before +++++++++++ +++++++++++ +++++++++
treatment +++++++++++ +++++++++++
+++++++++++ +++
After treatment ++++++++++ ++++++++++ +
10 weeks later ++++++++++ +++++++
73% recovered ++++++++++
++++++++++
+++++++++

10. CRUfADclinic: Roll out to clinicians

11. CRUfADclinic course design:
• Each course has 6 lessons
• „Cartoon‟ story of a person with the disorder who
recovers with advice
• Written instructions for patients to download to
reinforce the advice
• Testimonials from patients
• Relapse prevention is always lesson 6

15. Panic: Confronting fears

16. Roll out of CRUfADclinic.org to all rural
physicians in Australia
• Patients approve
• “I was sceptical of an online program as opposed to
an actual clinic. I found the first session great.
• CRUfADclinic has a very professional feel about it
• After spending years explaining my symptoms to
Doctors and Psychologists it is a relief to find help
where I can get on with fixing the problem.”

17. iCBT = face to face CBT. Efficiency 13:1

18. CRUfADclinic.org is good science
It treats patients with respect
It is simple to use
Requires little staff time
Most people like it and do well

19. Roll out to the world
• Negotiating with US, Canada, New Zealand
• With WHO, aiming at the BRIC countries
• Simple to translate for the E U
• Talk to me if you‟re interested
• gavina@unsw.edu.au
• Else just purchase a prescription book
• www.crufadclinic.org
• $100 buys 20 prescriptions