The purpose of the Mastermind project, an EU co-funded initiative within the 7th Framework Programme, is to implement at scale evidence based computerised Cognitive Behavioural Treatment (cCBT) services for depressed adults across a number of EU and Associated Countries, and from this implementation:
- Identify the barriers and success factors to implement cCBT on a large scale in different political, social, economic and technical health care contexts and from the perspective of different stakeholders such as patients, professionals and health insurances.
- Recommend successful strategies for implementing cCBT in these different contexts/settings.
‘Supera tu depresión’ (‘Get over your depression’) is the answer to the objectives settled by the Mastermind project, put in place by the Spanish public organizations which are part of the international consortium: Servicio Aragonés de Salud, Kronikgune, Osakidetza, Consellería de Sanidade de Galicia and Servizo Galego de Saúde and Badalona Serveis Assistencials (all of them acknowledged as the Spanish Cluster).
‘Supera tu depresión’ is an interactive multimedia programme composed by 9 modules (8 sequential compulsory modules and one optional extra unit about healthy habits). Modules 1 to 8 have been designed to be completed in one-week time, so ideally the whole program should last in 8 weeks, even though some delays are allowed that would make the treatment last for 12 weeks.
The therapy begins with an explanation about depression, meant to deal with all the stigma around it and continues by activating the patient through the inclusion of pleasant activities in the care recipient’s daily life. The second part of the program addresses the relation between thoughts and mood in order to empower the patient through different techniques to analyse negative thoughts, to construct a positive attitude and to increase their social activities.
On the one side, each module encloses two connected elements: a section of contents and a set of activities. The section of contents is presented in three different formats: a 6-minute video, a pdf file and an interactive text. Every week patients must work with this section of contents and are accordingly requested to also perform the set of tasks related to the module they are working in. Examples of these activities are the daily registration of feelings through a mood scale and routine relaxation activities. Further to that, the user is also requested to fill-in some on-line clinical questionnaires that help to monitor his/her evolution (i.e. PHQ9 or EQ5D).
On the other side, professionals can supervise the patients’ evolution in the treatment by reviewing their activity and performance, the daily mood record and the answers to the clinical questionnaires. Performing in such a way, the clinical monitoring of the patient and the evaluation of clinical results is safe and performed according to the pre-defined study protocol. Even so, it’s also true that the great automation of the intervention grants a relatively follow-up by the professional and provides an excellent alternative to standard psychotherapy treatment.
The Spanish Cluster
Currently, a number of computer treatment programmes have been developed and evaluated offering specific, cognitive behavioral techniques for treating depression. However, some of these tools are costly and therefore are not affordable for all patients. The Spanish Cluster was formed with the aim of validating a cognitive behavioral therapy application sustainable, effective and appropriate to treat depressive disorders.
In this sense, the Spanish Cluster designed an intervention protocol adapting the generic Mastermind’s study protocol. This adjustment includes more clinical tests to be performed before, during and after treatment in order to obtain as much information as possible to perform the evaluation. Another synergy to be highlighted is the co-production and use of all the video materials produced within the local technological platforms.
Each partner has integrated ‘Supera tu depresión’ contents into its own Information Systems – that allows low maintenance costs- and have implemented the protocol within its own institution taking into account the resources and the internal structure available at each site. Because of that, ‘Supera tu depresión’ is being piloted in the public health care systems of four Autonomous Communities (Aragón, Basque Country, Galicia and Catalonia).
Another difference between the different partners is who conducts the recruitment of the patients. In general, it is made by selected GPs who have received training about the cCBT and the usage of the technological tool. In other sites, psychiatrists and psychologists are also involved in the recruitment process. The follow-up and the alarm management are performed either by specialised contact centres or the referrers themselves.
The program includes a final assessment session to be performed by both the patients and the professionals, which is devoted to evaluate not only on the clinical effectiveness but also usability and quality of life facets.
After two years since the project started, we are now able to take some perspective and conclude that the multidisciplinary approach, with a strong focus in knowledge sharing on online cCBT and depression management has been the key point of the success of this design and implementation experience. It must be also noted that the cluster also took advantage of the knowledge transfer coming from the partners of the 1st deployment wave within the Mastermind project. This allowed a faster design process and development while avoiding classical implementation mistakes.
Another good example of that knowledge transfer is the Mastermind’s blog, accessible through the project’s webpage, where all the partners keep sharing their best practices and lessons learnt for anyone within the e-mental health community to learn. In there, anyone may find a nice video of the Spanish Cluster members, explaining their collaboration experience and encouraging others to join.
The project has now entered in its final phase; with all the pilots running at full speed. Right now, the main objective aims to generate enough evidence about the intervention and because of that a strong evaluation framework has been put in place based in the Model for ASsessment in Telemedicine (MAST).
By Spanish Cluster
(Servicio Aragonés de Salud, Kronikgune, Osakidetza, Consellería de Sanidade de Galicia and Servizio Galego de Saúde and Badalona Serveis Assistencials)