The development of our services was triggered by the personal experience of two of our company’s founders. One had no choice but to join a long waiting list for face-to-face psychological support when he was in profound need, and the other sought online help because she had too high anxiety to even make contact with mental health services. We learned through testing and critical evaluation that Acceptance and Commitment Therapy (ACT) is particularly well-suited for online delivery, with outcomes on a par with face-to-face delivery.
The development of our services was triggered by the personal experience of two of our company’s founders. One had no choice but to join a long waiting list for face-to-face psychological support when he was in profound need, and the other sought online help because she had too high anxiety to even make contact with mental health services. We learned through testing and critical evaluation that Acceptance and Commitment Therapy (ACT) is particularly well-suited for online delivery, with outcomes on a par with face-to-face delivery.
In conjunction with Prof. Raimo Lappalainen of Jyväskylä University in Finland, a global authority in the field of Cognitive Behaviour Therapy and ACT, we developed programmes to provide online support for people struggling with low mood, anxiety and workplace stress. These form a low-intensity, discreet complement or alternative to face-to-face psychotherapy, available immediately when the need arises.
Our programmes are currently being used by several hundred people in the UK. Their feedback is typically very positive, for example: “The programme has made a huge difference over the past couple of months. I’m hoping this will continue in improving the quality of work and home life.”
This kind of feedback supports the measured outcomes we find in the PHQ-9, and GAD-7 scales, which users complete within the guided structure of the programmes.
Wider Support
Currently we are partnering with NHS and third sector providers, who use our online services as an alternative or as a complement to established therapy offerings, the prevailing approach being Cognitive Behavioural Therapy. This enables services to provide an evidence-based choice of therapeutic interventions and approaches to their clients.
Pennine Care NHS Foundation Trust delivers our programmes as part of their Healthy Minds Psychological Therapies (IAPT) service. Also in Greater Manchester our programmes are delivered by the psychological therapy team within Self Help Services. This organization is part of the large social enterprise, The Big Life Group, and Headsted’s programme for workplace stress, Shift Your Stress, is now offered to all employees of this organisation.
In addition, we have made our services available on an open access basis to the citizens of St Vincent and the Grenadines in partnership with the Ministry of Health and the Trinity School of Medicine. Mental health is a considerable challenge in this region, and primary care resources are limited, and our programmes form the central component of the ground-breaking Psychological Wellness Initiative.
Headsted’s novel utilisation of the ACT model has also attracted the support and interest of both the World Health Organization and the Pan American Health Organization.
We provide training to our partners and we have regular scheduled contact to review results and user feedback. We also work with them to establish the most productive and effective modalities to offer our programmes to their user base (e.g. telephone interaction with users in support of their self-managed online use).
Co-Production
In programme development, we have engaged users and practitioners in iterative user testing, building the programme content and service model on theory, expert knowledge and user feedback. We also actively solicit input from users and providers to guide us in updating existing programmes and developing new programmes. We have ongoing research collaboration with the department of psychology at University of Jyväskylä, Finland, who conduct studies on online ACT and provide us with up-to-date knowledge that can be applied into service development.
Looking Back/Challenges Overcome
Following the UK launch of Hold Your Nerve, the seven week programme for people struggling with anxiety, market demand facilitated the speed of development of our second and third offering to the UK(for low mood and workplace stress). In hindsight it might have been better to focus on a single programme for longer, learn from user feedback and data analysis, and refine it before embarking on other products. This would probably have been a more efficient use of our resources.
We were also primarily concerned with the clinical efficacy of our programmes, and could have dedicated more attention to establishing a sustainable business model to bring in revenue earlier.
Sustainability
The software underlying our programmes is robust and well-maintained, so should key personnel move on, it will be relatively easy for other people to step in. We also depend on key staff in our partner organizations for ensuring our programmes are offered. We have seen numerous staff changes in our partners, and we have always been able to actively and successfully manage the hand-over from the person moving on to their successor.
Evaluation (Peer or Academic)
Our “Value Your Self” programme has been the subject of a RCT study of our with an 18-month follow-up at University of Jyväskylä, Finland:
Lappalainen et al. (2014) ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: an 18-month follow-up. Behav Res Ther. 2014 Oct;61:43-54. http://dx.doi.org/10.1016/j.brat.2014.07.006
Lappalainen et al. (2015) Web-Based Acceptance and Commitment Therapy for Depressive Symptoms With Minimal Support, A Randomized Controlled Trial. Behaviour Modification Vol.39, Issue 6, 2015 http://journals.sagepub.com/doi/abs/10.1177/0145445515598142
Furthermore, the Headsted UK programmes are subject to ongoing independent evaluation by Liverpool John Moores University and Wrexham Glyndŵr University, the latter recently completed an evaluation of Shift Your Stress. The findings from this evaluation were presented at the European Association of Work and Organizational Psychology conference in Dublin, in May 2017.
Outcomes
An evaluation of our Shift Your Stress programme on 69 Self Help Services users (carried out in March 2017) showed a mean improvement in the PHQ-9 measurement of 4.5 (from 11.1 to 6.6) and a mean improvement of 4.8 in the GAD-7 measurement (from 10.1 to 6.3).
In a recent interim Shift Your Stress evaluation of 94 users out of whom 43 were classified as depressed and 52 as anxious/stressed, 72% achieved recovery with respect to depression (PHQ-9), and 62% achieved recovery with respect to Anxiety/Stress (GAD-7).
An interim UK evaluation of the completers of Hold Your Nerve programme on 91 Self Help Services users demonstrated recovery rates for PHQ9 and GAD7 of 57% and 52% respectively (sample sizes 21 and 27, respectively).
(The current national recovery rate for IAPT is 48.9%, with a target of 50% set by NHS England.)
Specific feedback users provide upon completion also gives us the confidence that our programmes have improved outcomes for them: • “I am glad I did the programme because now I feel better able to cope with my anxiety, also it made me feel as though I am not the only one having this problem. I found the mocking my thoughts exercise useful and the breathing techniques made me more relaxed.”
• “The topics and themes really resonated with me, made me acknowledge issues I am experiencing and have made me more mindful, informed and determined to find inner peace, health and happiness.”
• “The programme was very helpful and it gave me an understanding on how to deal with social anxiety.”
A qualitative evaluation of psychological wellbeing practitioners’ experiences of using the Shift Your Stress programme at Self Help Services demonstrated positive attitudes towards the programme. It also provided an alternative approach for clients who hadn’t benefited from CBT. • “Some people have tried just normal CBT and it hadn’t really worked, so they found it a little bit different, so I thought it was a really good way of putting things across to people.”
• “We’ve had a lot of people in a lot of different jobs it seems to have worked. There does not seem to be any career that it does not seem work for.”
• “I think it is helpful for the majority of people, really.”
Sharing
We are delighted to be able to share our knowledge and know how with the citizens of Saint Vincent and the Grenadines and offer them access to our services.
We also share our insights via our blog and social media.
Is there any information you would like to add?
Our programmes are among the first online e-therapies using ACT. They make use of interactive, experiential exercises, and use text, audio and video.
• They offer a low-cost approach to give immediate support to people who are on a waiting list to see a therapist. Given the results we see with many of our users, in many cases the need is successfully met through the online therapy, so that face-to-face therapy is no longer necessary, and scarce resources are freed up. Best outcomes are achieved when the online therapy is combined with brief contact with a practitioner, e.g. a weekly 15-minute phone call. Our programmes can be part of a strategy to provide better outcomes with less money.
• Because of its 24/7 availability, and its potential for anonymous use, our programmes can greatly improve access to psychotherapy to the all members of the public.
• Our Shift Your Stress programme can make a significant difference in situations of workplace stress for the wellbeing of the employee.
