Group Sessions Helpful for Mild Anxiety During COVID-19, Trial Finds

A remote, peer-facilitated group intervention created to provide mental health and social support during the COVID-19 pandemic significantly eased anxiety and depression in adults with systemic scleroderma and mild anxiety, according to data from the SPIN-CHAT trial.

Differences between the group of patients who underwent the one-month intervention and those who did not were evident only at six weeks post-intervention, rather than immediately after, failing to meet the trial’s main goal.

Group differences in anxiety and depression scores also were considered small, highlighting the need for further studies to assess the intervention’s effectiveness, its researchers noted.

The trial’s results, “Effects of a multi-faceted education and support program on anxiety symptoms among people with systemic sclerosis and anxiety during COVID-19 (SPIN-CHAT): a two-arm parallel, partially nested, randomized, controlled trial,” were published in The Lancet Rheumatology.

The COVID-19 pandemic disrupted aspects of daily life worldwide. People with pre-existing medical conditions like scleroderma that put them at risk of COVID-19 complications, in particular, have a higher risk of poorer mental health, with higher levels of anxiety, fear, loneliness, and depression.

In agreement, previous studies showed that scleroderma patients experienced a substantial increase in anxiety following the onset of the pandemic.

The World Health Organization (WHO) and other public health groups have recommended multi-faceted strategies to support mental health during the pandemic.  But scientific support of their effectiveness requires an appropriately controlled trial.

The interventional, international SPIN-CHAT study (NCT04335279) was one of the first controlled trials to evaluate mental health interventions during the COVID-19 pandemic. SPIN-CHAT stands for scleroderma patient-centered intervention network COVID-19 home-isolation activities together.

The trial investigated a multi-faceted, videoconference-based group intervention designed to lessen anxiety or other mental health symptoms in 172 adults with systemic sclerosis and at least mild anxiety symptoms, suggesting a risk of poor mental health.

Participants were recruited through social media announcements and from an existing group of scleroderma patients (the SPIN group), which includes adults from the U.S., Canada, Australia, France, Mexico, Spain, and the U.K., who have been completing patient-reported outcomes online every three months since 2014.

Eligible participants had not tested positive for COVID-19, were not currently receiving mental health counseling, and had to be fluent in English or French.

Overall, the mean age of the people analyzed was 55, they had been living with scleroderma for a mean of 11.3 years, and 94% were women.

Patients were randomly assigned to either the intervention (86 patients) or to a waiting list (86 patients), where the program would be given after a six-week assessment following the intervention.

The intervention’s design was based on recommendations from the WHO and public health organizations, and in collaboration with scleroderma patients to meet their specific needs.

It delivered education, anxiety, and mental health coping strategies, adapted home exercise, and social support to groups of six to 10 patients that met via videoconferencing for 90 minutes, three times a week for four weeks.

The groups were facilitated either by scleroderma patients or trained staff members of patient organizations. Participants were also provided with access to resource material to support each strategy.

The study’s main goal was changes in anxiety after the final session, while secondary goals included changes in anxiety symptoms six weeks post-intervention, and changes in depression symptoms, fear, loneliness, boredom, and physical activity after the final session and six weeks later. All were assessed with validated measures online.

Results showed that participants attended a mean of 8.8 sessions, with 13% of them attending none, and 44% attending all 12 sessions.

About two months post-intervention, most (82%) group facilitators reported that their group continued to meet regularly. About 20% of participants in both the intervention and the waiting list groups started to receive mental health services, such as counseling or psychotherapy, after the study.

Notably, the intervention did not significantly reduce anxiety, or any of the other evaluated mental health symptoms, by the end of the intervention period, failing to meet the trial’s main goal.

But intervention group patients had significantly lower anxiety and depression scores (indicative of fewer symptoms) at six weeks post-intervention compared with those on the waiting list.

“This might reflect the time needed to make behavioral changes or the ongoing social support that participants continued to provide to each other post-intervention,” the researchers wrote.

Still, group differences in anxiety and depression scores were considered to reflect small to medium effects.

These small effects may be related to a greater difficulty in assessing anxiety changes in people with mild symptoms or to the fact the intervention may not have included a sufficient amount of the therapeutic components known to work in treating anxiety or depression.

“Addressing the mental health needs of the public, including vulnerable individuals, during COVID-19 is an increasingly important challenge as the length of the pandemic extends,” the team wrote.

This and similar interventions “might be attractive options because they represent a relatively low-resource option that provides skills training and support to up to ten people at a time,” the researchers added, noting that future studies are needed to clarify and/or improve the effectiveness of this type of intervention.

In an accompanying comment, Jill M. Newby, PhD, a clinical psychologist at the Black Dog Institute in Australia, said the study also highlights the importance of established global consortia and the SPIN patient group that were “ready to rapidly respond to address the mental health challenges of COVID-19.”

Its findings also emphasize “how essential it is to test, rather than assume what interventions work to improve mental health in susceptible groups during pandemic situations,” Newby added.