Supporting Peer Interactions to Expand Access to Digital Cognitive Behavioral Therapy for Spanish-speaking Patients

Launched by UNIVERSITY OF CALIFORNIA, IRVINE · Feb 16, 2023

Keywords

ClinConnect Summary

This study, called SUPERA, tests a Spanish-language digital cognitive-behavioral therapy (dCBT) program for adults with depression and/or anxiety who receive care in safety-net primary care clinics. It compares two ways of delivering the program: (1) a Supported dCBT, where participants get full access to the SilverCloud platform plus weekly help from a peer supporter, and (2) an Unsupported dCBT, where participants use the platform on their own with no extra coaching. The study also compares two ways clinics might identify eligible patients—outreach using a clinic patient registry versus traditional provider referrals—to see what helps more people start the program. This is being tested across several U.S. clinics to see how well it works in real-world care.

Who can join? Adults 18 and older who have at least moderate symptoms of depression or anxiety (PHQ-9 score of 10 or higher, or GAD-7 score of 8 or higher) and who have internet access, preferably in Spanish, may be eligible. Participants should not be in ongoing psychotherapy and should have a stable antidepressant dose if they’re taking one. They will enroll for 8 weeks on the SilverCloud platform; the Supported group will receive regular help from a peer supporter, while the Unsupported group will use the platform without that extra support. The study’s main goal is to see whether adding peer support reduces symptoms of depression and anxiety by 8 weeks, with additional measures looking at functioning, stress, wellbeing, and how much participants use CBT skills. About 426 people are planned to enroll, and results will be shared in a national research data system after the study ends.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. PHQ-9 ≥ 10 or GAD-7 ≥ 8
• • 2. Has access to the Internet via smartphone and/or broadband at home, and basic level of technological literacy or willingness to undergo a brief technology use training
• • 3. ≥18 years of age
• • 4. Preference for receiving medical care in Spanish
• • 5. Not in concurrent psychotherapy
• • 6. If currently taking an antidepressant medication, patient must have been on a stable dose for at least 6 weeks, and have no plans to change the dose. We will permit patients on antidepressants to enter the study, as this will increase generalizability. Antidepressant status will be monitored at each assessment to control for those effects, if necessary.
• Exclusion Criteria:
• • 1. Currently receiving psychotherapy, as this treatment will be offered as a frontline treatment for depression and anxiety, however, patients are allowed to be referred to treatment while participating in this study and initiation of treatment will be monitored and considered in analyses
• • 2. Visual, hearing, voice, or motor impairment or illiteracy that would prevent completion of study procedures
• • 3. Diagnosis of a psychotic disorder, bipolar disorder, dissociative disorder, or substance use disorder
• • 4. Severe suicidality (as assessed by expressing suicidal ideation, plan, and intent). Although procedures with back-up plans are in place for patients who develop suicidality (see Human Subjects Section), patients assessed with severe suicidality will be referred to more-intensive treatment resources.