Just a Thought is an online learning tool for New Zealanders to help improve their mental wellbeing. Anyone in New Zealand can use the tool but it is aimed at people with mild-to-moderate symptoms of anxiety or depression who are over 16 years of age.
Just a Thought offers free cognitive behavioural therapy (CBT) courses online, which teach people how to improve their mental health through learning how to interact differently with their thoughts and identify their behaviours. Users can either enrol themselves (self-care method) or have the course prescribed by their healthcare professional (eg, their GP, psychologist or nurse). Healthcare professionals can follow their patient's progress through a clinician dashboard.
Essentially the tool comprises 2 courses:
Generalised anxiety course to help people reduce their worry, anxiety and physical symptoms, both in the short and long term.
Depression course to help people reduce their symptoms of depression, both in the short and the long term.
The courses are a step-by-step programme that comprises 6 lessons which take about 20–30 minutes to complete. You can take the programme at your own pace over 3 months. It is best to do one lesson every week or two, so you have time to practise between lessons. There is a built-in 5-day lockout period between lessons. You will be emailed when your next lesson is available. You get 90 days access to your course. When you complete the course, you get an extra 12 months access so you can revisit the course at any time.
The amount of support you receive depends on how you choose to do the course. If the healthcare professional you are working with prescribes it for you, they will receive updates on your wellbeing and progress so they can support you.
Just a Thought is based on the This Way Up programme from the University of New South Wales and St Vincent Hospital in Australia. The Wise Group purchased the tool and spent over a year enhancing and adapting it for the New Zealand environment and people.
For the complete description, go to the website or, for a more detailed review, see Reviews.
✔ There is a good evidence base for online CBT programmes.
✔ Modified for New Zealand from the Australian programme This Way Up. This Way Up has been extensively researched showing benefit for many mental health disorders, making this programme truly evidence based.
✔ There are 2 available courses at the time of writing: one for depression and one for generalised anxiety disorder. Each course has 6 sessions. There are plans for further courses for other mental health conditions.
✔ Fairly interactive. Each session starts with a comic-book style slide show (with much-improved graphics compared to the Australian version), and then moves onto the summary section, which include sections for filling out your own thoughts, goals, etc.
✔ Sessions include validated mental health screening questionnaires (skippable).
✔ The clinician can monitor patient course progress and mental health questionnaire scores but cannot interact in any way on the platform.
✔ Suitable for both adolescents and adults.
✘ No mobile app, but the web page is mobile optimised. Best suited for tablets, laptops or desktop computers.
✘ At the time of this review, there are no courses for mental health conditions other than depression and generalised anxiety disorder. The Australian version has 20 different courses (eg, for PTSD, insomnia, chronic pain and a course for clinicians). There are are plans for more to be adapted.
✘ There are many disadvantages to online CBT. These include: - low adherence when unguided - lack of direct monitoring unless the patient's practice is setup for this - technology accessibility - higher English literacy requirement.
✘ The Australian version of This Way Up has a fairly high English literacy requirement, but Just a Thought has been modified to reduce the literacy requirement.
✘ Not available in languages other than English.
Date of review: January 2020 Platform reviewed: Online Version: Accessed Dec 2019–Jan 2020
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The clinical score depends on the context in which Just a Thought is used.
If guided by a relevant health professional with phone or email follow up, or self-guided for highly motivated patients:
If self-guided due to high risk of non-adherence. However, even completing one session could be helpful:
If the user has a mental health condition other than what is offered in the available courses. However, they may still find the them useful:
Reviewer: Jeremy Steinberg, GP, RNZCGP Date of review: January 2020 Comments: Just a Thought is a modified version of the well-known Australian programme This Way Up. Compared to This Way Up there is reduced content, improved graphics, reduced literacy requirements, and modifications for the New Zealand context. In general, many randomised controlled trials have shown online CBT to be effective for a variety of psychiatric illnesses compared to wait-list controls.2 There appears to be only one study (at the time of writing) that directly compared online CBT to traditional face to face counselling; this was conducted in patients with panic disorder and it showed similar outcomes.
There are no trials looking at Just A Thought in the New Zealand context, but the Australian version This Way Up does have extensive research support.3 The Australian context has some key differences, and so the research should only be cautiously applied to New Zealand while awaiting data. They are looking at doing New Zealand based research in the future.
There are disadvantages and barriers to access with online CBT programmes. These include the lack of direct monitoring, low adherence, technology accessibility and high literacy requirements. Guidance during the course from a real person can mitigate some of the disadvantages, where the user has access to a therapist.2 Guidance is supported in a limited way with Just a Thought. The GP or nurse can view patient course progress and mental health questionnaire scores. There is no messaging function but adding that could have downsides.
When unguided, low adherence is of particular concern for this type of programme. Only 27% of unguided users of MoodGYM (an Australian online CBT service) completed the course.4 In general, online therapy when guided by GPs can reach 40–60%, and when guided by psychologists can reach 90%.2 Interestingly, This Way Up saw improved adherence when they added a financial cost to their courses (Just a Thought is free).5 The GP practice could set up a patient phone monitoring system, which would probably be the most cost-effective option for improving adherence and increasing the human connection, but funding for this may not be available depending on the PHO. As few as two phone follow up calls may be all that is required.5
It is well recognised that there is a large unmet mental health need in New Zealand, and many New Zealanders are not able to access funded face-to-face talking therapies, or if they can access this then the number of sessions is highly limited. I think it is highly commendable that there is this free evidence-based self-guided option available. From a public health perspective, I worry that in the New Zealand context with poor access to face to face counselling, the barriers to access for online CBT programmes could serve to further widen the current disparities in mental healthcare in New Zealand.1
The main areas of improvement that I see are adding the other 18 courses from the Australian version, potentially adding more features to support clinician guidance, and adding proper mobile support in the form of a native app for android and iOS with notifications. Practice management software integration could be helpful.
Overall this is an evidence-based intervention that health professionals can recommend to their patients or that users can sign up for individually. Due to the risk of course non-completion, it is best suited to highly motivated users, or to users who are registered at practices that offer regular phone follow up. PHOs should consider funding practices to do phone follow-ups for online CBT programmes. Just a Thought have been lobbying the relevant players to provide support to GP practices to offer follow-up support within this model. Safety concerns: If not communicated properly, the patient could wrongly believe their GP or nurse is remotely monitoring their progress if their GP practice doesn’t offer that service. New Zealand relevance: Relevant; modified for the New Zealand context.