(084) Feasibility of Utilizing an App Based Digital Cognitive Behavioral Intervention in Patients with Epilepsy
Abstract: Background/Significance:
Mood and anxiety disorders are common comorbid conditions in people with epilepsy with prevalence ranging from 20-50% depending on seizure control. Many studies on health-related quality of life (HRQOL) of people with epilepsy have noted that a patient’s depression is the single most important factor in predicting HRQOL (Kwon 2014). Traditional cognitive behavioral therapy (CBT) is recommended to treat patients with depression and anxiety in patients with epilepsy (Michaelis 2018). However, access to CBT is often inadequate. Implementation of a coached digital cognitive behavioral intervention (dCBI) via an app may help improve access among patients with epilepsy. App-based dCBI has been previously evaluated in other chronically ill populations (Szigethy 2021). We evaluated the feasibility of utilizing app-based dCBT as a first line intervention in patients with epilepsy and anxiety or depression at an epilepsy center at an academic hospital.
Methods:
Patients 18 years and older with anxiety and/or depressive symptoms were offered a dCBI (an app called RxWell) during routine clinic visits. RxWell provides cognitive behavioral techniques enhanced by within-app text messaging with a health coach. Both epileptologists and behavioral health-care providers prescribed RxWell through the electronic medical record. We tracked patient interactions with RxWell, and patients completed anxiety (General Anxiety Disorder-7) and depression (Personal Health Questionniare-9) baseline scores through the app.
Results:
Of 146 patients (mean age 40.2, 65% female) who were offered a dCBT (an app called RxWell), 45.2% of patients downloaded the app. For those who downloaded the app, the median number of techniques used was 1.5 and 36.3% of patients interacted with the health coach. The mean baseline GAD-7 score was 12.7 (Standard Deviation = 5.6) and mean baseline PHQ-9 was 13.2 (Standard Deviation = 5.6).
Discussion:
Patients with epilepsy and anxiety or depression are willing to use app based dCBT recommended by both epileptologists and psychiatrists within an epilepsy center at an academic hospital. Engagement with the app and digital coach by patients and providers was substantial, although lower than has been seen in other settings (Szigethy 2021). Patients had moderate baseline depression and anxiety scores. Coached dCBT should be evaluated further for efficacy in treatment of anxiety and depression in patients with epilepsy.
Kwon OY, Park SP. Depression and anxiety in people with epilepsy. J Clin Neurol. 2014 Jul;10(3):175-88.
Michaelis R et al. Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia. 2018 Jul;59(7):1282-1302.
Szigethy E et al.. A Coached Digital Cognitive Behavioral Intervention Reduces Anxiety and Depression in Adults With Functional Gastrointestinal Disorders. Clin Transl Gastroenterol. 2021 Dec 7;12(12):e00436.