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Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’


Objectives There is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services. Therefore, this service evaluation reports on feasibility and outcomes from an eTherapy mental health service.

Setting ‘Self Help Services’, an Increasing Access to Psychological Therapies (IAPT) eTherapy service in Greater Manchester.

Participants 1068 service users referred to the service for secondary care for their mental health difficulties.

Interventions Participants were triaged into one of three eTherapy programmes: ‘Living Life to the Full Interactive’ for low mood, stress and anxiety; ‘Sleepio’ for insomnia; and ‘Breaking Free Online’ for substance misuse, depending on clinical need.

Primary outcomes measures Standardised psychometric assessments of depression, anxiety and social functioning, collected as part of the IAPT Minimum Data Set, were conducted at baseline and post-treatment.

Results Data indicated baseline differences, with the Breaking Free Online group having higher scores for depression and anxiety than the Living Life to the Full Interactive (depression CI 1.27 to 3.21, p<0.0001; anxiety CI 077 to 1.72, p<0.0001) and Sleepio (depression CI 1.19 to 4.52, p<0.0001; anxiety CI 2.16 to 5.23, p<0.0001) groups. Promising improvements in mental health scores were found within all three groups (all p<0.0001), as were significant reductions in numbers of service users reaching clinical threshold scores for mental health difficulties (p<0.0001). Number of days of engagement was not related to change from baseline for the Living Life to the Full or Sleepio programmes but was associated with degree of change for Breaking Free Online.

Conclusion Data presented provide evidence for feasibility of this eTherapy delivery model in supporting service users with a range of mental health difficulties and suggest that eTherapies may be a useful addition to treatment offering in community-based services.

  • eTherapies
  • mental health
  • cognitive-behavioural therapy
  • service evaluation
  • sleep medicine
  • substance misuse

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  • Contributors SE led on study design, data analyses, literature review and drafting the manuscript. JW developed the Breaking Free Online treatment programme and co-wrote the manuscript. CW developed the Living Life to the Full Interactive treatment programme and provided comments on the manuscript. CE developed the Sleepio treatment programme and provided comments on the manuscript. GD developed the Breaking Free Online treatment programme and provided comments on the manuscript. SD assisted with literature review and data analyses. KR provided support to service users in accessing the three eTherapy programmes, collected outcomes data and assisted with access to the data. LC provided support to service users in accessing the three eTherapy programmes and collected outcomes data. NL provide permissions for accessing the data, organised access to the data and provided comments on the manuscript. KS extracted data for analyses and provided these to the lead author.

  • Competing interests SE, GD and SD are employed by Breaking Free Group, where the Breaking Free Online programme was developed. JW and GD are authors of the Breaking Free Online programme. JW is founder and a director and shareholder of Breaking Free Group. CW is President of BABCP, the lead body for CBT in the UK, and is also author of Living Life to the Full Interactive as well as a range of other CBT-based resources that address anxiety, depression and other disorders, which are available commercially. He receives royalties for these and is shareholder and director of a company that commercialises these resources. CE is co-founder and CMO of Big Health Ltd (Sleepio), where he is a shareholder and receives remuneration from the company.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval This was a service evaluation using existing, non-identifiable service user data from Self Help Services, which were fully anonymised by Self Help Services before being provided to the lead author for analyses, and so external ethical approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available as all data provided by Self Help Services for the purposes of the study are reported in the manuscript. Self Help Services collects additional confidential data on their service users, though this was not required for this study.

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