Increasing Access to Evidence-based Treatments for Depression: The Development and Evaluation of a Digital Training Platform for Interpersonal Psychotherapy.

Background/Rational

The COVID-19 pandemic is expected to have an unprecedented impact on the mental health and well-being of patients, healthcare workers and our society at large. Among these illnesses, depression is expected to be the most prevalent to emerge and is already the leading cause of disability worldwide; it affects up to 1.8 million Canadians. While physical distancing is required to curb the spread of COVID-19, it is well known that social isolation is a substantive risk factor of mental illness and suicide.

Effective treatments exist but as few as 20% of Canadians receive minimally-adequate treatment for depression. One effective treatment for depression includes Interpersonal Psychotherapy (IPT) which may be particularly relevant for the isolation and life changes brought on by the COVID-19 pandemic. IPT is recommended in key consensus guidelines from the World Health Organization and the Canadian Network for Mood and Anxiety Treatments. IPT is a brief, structured psychological treatment that has been shown to effectively reduce depressive symptoms and enhance remission rates for patients across the lifespan. IPT proposes that the key to reducing depression is to increase connection with social supports and help patients work through triggering interpersonal experiences of loss/grief, life changes/social role transitions, interpersonal sensitivity/loneliness, or relational conflicts/role disputes. We selected IPT for three reasons: i) its strong evidence base for effectiveness as an antidepressant treatment, comparable in efficacy to CBT, with fewer patients dropping out of treatments; ii) its effectiveness in treating depression among culturally diverse patients across the lifespan; and iii) its parsimonious approach that is easy to understand and implement. This is critical when training novice clinicians. The poor dissemination of effective psychological therapies such as IPT is partly due to the limited number of available mental health professionals who can train novice clinicians with high fidelity; and one key obstacle is how these individuals are trained. Prior to the COVID-19 pandemic, this typically involved a trainee attending an expert-led workshop and then practicing the treatment under the supervision of someone experienced in delivering that treatment. The recent development of digital training platforms in various psychological treatments has attempted to address this training gap. In addition, web-conferencing applications have opened the door for distance psychotherapy training and supervision.

Online training methods need to be developed and examined to address this significant bottleneck, particularly in light of the current COVID-19 pandemic where in-person trainings have stopped but the need for evidence-based psychotherapy grows. The current study aims to examine two online training methods with consenting psychiatry resident/trainee therapists: a) asynchronous self-directed training through a novel digital training course which they will complete on their own schedule; and b) synchronous large group workshop where residents will participate in a live training workshop at a specific time. Asynchronous training is a more cost-effective and scalable method of training which permits residents (and other trainees) to learn psychotherapy according to their preferred schedules. To date, several asynchronous IPT training courses have been developed, however none have been compared to synchronous large group online workshop. The current study will provide preliminary evidence to examine the acceptability and feasibility of both models among psychiatry residents at University of Toronto affiliated hospitals.

Purpose