Category: BA

Transdiagnostic Internet-delivered Cognitive Behaviour Therapy: Utility of a Motivational Interviewing Resource

Honours Thesis Results, Sasheen Horse 2022

Background: There is strong evidence for the effectiveness of internet-delivered cognitive behaviour therapy (ICBT) but clients can struggle with motivation during treatment. Online motivational interviewing (MI) has not yet been investigated during ICBT as a method of facilitating engagement and outcomes.

Purpose: This feasibility study investigated the potential use of an MI resource offered during ICBT by examining: (1) use of the resource; (2) patient and treatment variables associated with using the resource; (3) whether use of the resource was associated with improved engagement and outcomes; and (4) how those who used the resource evaluated it.

Method: This study used data collected from 763 clients enrolled in an ICBT course. Clients completed an MI resource evaluation measure at post-treatment. Symptoms were assessed at pre- and post-treatment. The website tracked treatment engagement.

Results: Approximately 15% of clients used the resource. Clients who were older, had higher education, higher depression, and lower anxiety at pre-treatment were more likely to use the resource. Those who reported using the resource had higher engagement (i.e., more lessons and more messages) in ICBT, but lower improvement in disability, which may have been a trigger for using the resource. Positive feedback on the MI resource outweighed the negative feedback, with 94% of clients identifying a positive aspect of the resource and 68% of clients reporting changes made in response to the resource.

Conclusion: Overall, the MI resource appears to have utility for a small portion of clients who complete ICBT and this study provides insight to who will use the resource. The resource will be available longer term for patient use in the Online Therapy Unit.

Transdiagnostic Internet-delivered therapy among post-secondary students: Are booster lessons beneficial?

Honours Thesis Results, Taylor Patterson, 2021

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be effective among post-secondary students. Booster lessons have been proposed as a strategy for maintaining and improving outcomes but have yet to be investigated among students.

Method: To inform future use of booster lessons with students completing iCBT, this study used a mixed-methods approach to identify student (n = 101) use of a booster lesson, predictors of completion, and student preferences regarding delivery of a booster lesson one month following a 5-week transdiagnostic iCBT course.

Results: Approximately one-third of clients utilized the booster lesson; among this group the booster lesson was perceived as worthwhile, client satisfaction was high, and every client who completed the booster indicated that the length was appropriate. Clients provided varied responses regarding the ideal timing of a booster lesson (1-2 weeks to 3-6 months) and whether therapist support is preferred while completing the lesson (50% of completers and 40% of non-completers expressed preference for therapist support). The only significant predictors of use of the booster lesson were the number of iCBT lessons completed and whether the client was currently receiving treatment for mental health concerns. School-related time constraints (27.0%) were identified as a large concern for non-completers.

Conclusions: Understanding client use and gaining feedback about their preferences provides direction for future research to maximize the likelihood a booster lesson would be beneficial. Future research incorporating a booster lesson in iCBT should consider student preferences and exhibit flexibility to elevate client engagement.

Pre-treatment change in Internet-delivered alcohol use disorder treatment

Honours Thesis Results, Carly Chadwick 2020

Background: Alcohol misuse is a common mental disorder that can have devastating effects on an individual’s physical and mental health. Although alcohol misuse is both prevalent and disabling, only 21% of individuals receive treatment. Internet-delivered cognitive behaviour therapy (ICBT) may serve as a promising solution for the treatment gap, as it minimizes concerns about the stigma surrounding seeking treatment. Previous studies in alcohol treatment literature address a phenomenon named Assessment Reactivity (AR) which suggests that assessment interviews are predictive of significant changes in pre-treatment drinking. This may be of clinical importance as early abstinence from alcohol has been significantly associated with longer periods of continuous abstinence.

Purpose: The primary objective of the current study was to explore pre-treatment change by experimentally manipulating assessment in an ICBT program for alcohol misuse.

Method: The present study used data from 87 clients who were randomly assigned to receive an assessment interview or no assessment interview prior to beginning treatment.

Results: Results indicated that there were no significant differences in drinking behaviours between groups at pre-treatment. However, significant reductions in alcohol consumption were observed amongst both groups, suggesting that factors other than an assessment interview may contribute to client’s willingness to improve their drinking behaviours. No significant differences in motivation to change or depressive symptoms were observed between groups, although, both groups experienced a significant increase in motivation and decrease in depressive symptoms over time. 

Internet-delivered Cognitive Behaviour Therapy for Chronic Health Conditions With and Without Guidance: Exploring Changes in Benefit Finding

Honours Thesis Results, Giuliano La Posta 2019

Background: Internet-delivered cognitive-behaviour therapy (ICBT) is effective in reducing symptoms of anxiety and depression when targeted to specific groups with chronic health conditions (e.g., pain, cancer, cardiac, spinal cord injury). Nevertheless, there are some gaps in the literature regarding:

•  the efficacy of ICBT programs that are transdiagnostic and address multiple chronic health conditions;
• whether outcomes are improved when offered with support of team of providers compared to when ICBT is self-directed; and
• whether ICBT is associated with improvements in benefit finding.

Purpose: To examine the efficacy of self-directed versus team-directed transdiagnostic ICBT Chronic Health Conditions course in improving benefit finding, as well as anxiety and depression among individuals with diverse chronic health conditions.

Method: Participants were divided into self-directed (n=15) and team-directed (n=16) groups and were measured for changes in benefit finding scores, as well as in anxiety and depression symptoms, at both pre-treatment and post treatment.

Results: There were no between group differences or interactions. For both self-directed and team-directed groups, significant time effects were present for anxiety (Cohen’s d=0.83), depression (Cohen’s d=0.69), distress (Cohen’s d=0.65) and disability (Cohen’s d=0.18). Benefit finding did not change significantly over time, although a small effect was seen when examining Cohen’s d=.30.

Conclusion: The transdiagnostic ICBT Chronic Conditions course when either self-directed or team-directed shows promise in reducing symptoms of anxiety and depression, distress, and disability over time.

Patient perspectives of internet-delivered cognitive behavioural therapy for psychosocial issues post-spinal cord injury

Honours Thesis Results, Danielle Earis 2018

Background: Individuals with a spinal cord injury (SCI) confront numerous physical and psychological adjustments. Many report clinically significant depression and anxiety disorders post-SCI; thus, attention to psychological distress is crucial. Cognitive behaviour therapy (CBT) has been shown to be effective in reducing anxiety and depression. Despite the availability of treatment, there are barriers such as accessibility, cost, and transport to appointments. Internet-delivered CBT (ICBT) can increase access to psychological services.

Purpose: The purpose of this study is (a) to evaluate patient perspectives on the acceptability of an eight-week guided ICBT course (Chronic Conditions Course for Persons with SCI) and (b) to gain understanding of SCI experiences that may impact ICBT.

Method: Semi-structured interviews were conducted with patients (n = 8). The interviews were audio-recorded, transcribed verbatim, and examined by means of thematic analysis. Emerging themes were summarised and explored.

Results: Patient comments were organized into three broad categories: SCI experience, ICBT experience, and ICBT outcomes. Interviews provided insight into SCI outcomes and support ICBT acceptability with identified strengths (e.g., accessibility, flexibility, guided support). Suggested changes included improved breadth of case stories, course timeframe, and more support from the guide.

Implications: This research provides a better understanding of ICBT as an acceptable treatment for psychosocial issues post-SCI. Patient feedback provided valuable information for improving and tailoring the ICBT course to the SCI population and in understanding SCI experiences.

Client correspondence in Internet-delivered cognitive behaviour therapy: An examination into client communication with therapists and symptom improvement

Honours Thesis Results, Catherine Couture 2017

Background: Internet-delivered cognitive behavioral therapy (ICBT) is an efficacious treatment for anxiety and depression. Most ICBT programs include therapist assistance in the form of secure online messaging; however, a high degree of variability has been found in the content of client and therapist correspondence. Recent research conducted by Svartvatten et al. (2015) found that client statements suggesting alliance bolstering and text expressing a positive change in mood after the implementation of a suggested skill or exercise appear to correlate with greater symptom improvement.

Purpose: The current study sought to examine: (1) if previously identified themes in client communication with their Internet therapist (Svartvatten et al., 2015) would replicate in a transdiagnostic ICBT program for depression and anxiety; and (2) if these themes correlated with symptom improvement and treatment completion. 

Method: The present study used data from 80 randomly selected patients from a previously published trial of ICBT for depression and or anxiety. Client emails (on average 5.69 per client) were examined for the presence of 10 themes reported by Svartvatten et al. (2015).

Results: Statistically significant differences were found in the frequency of all themes between the two studies. Further, in the current study, greater frequency of statements classified as maladaptive repetitive thinking and problems with treatment content correlated with smaller improvements in symptoms of anxiety from pre- to post-treatment.

Implications: This research provides a better understanding of the parameters of client communication and information for future therapists regarding the content of clients’ correspondence in ICBT.

Analyzing therapist emails in Internet-delivered cognitive behavioural therapy

Honours Thesis Results, Kristen Klassen 2017

Background: Internet-delivered cognitive behaviour therapy (ICBT) arose as a response to barriers associated with face-to-face therapy and has shown to be efficacious especially when offered with therapist assistance.

Objective: Despite the importance of therapist-assistance to ICBT, there has been minimal research on this topic. No scales have been developed to specifically assess presence of therapist behaviours during ICBT. As such, the purpose of this study was to: 1) develop an ICBT rating scale that captures the main elements of the therapist/client interactions in secure email messages, and 2) evaluate a random selection of ICBT therapists using this scale to assess average ratings on therapist/client interactions during the course of ICBT.

Method: The initial scale was developed based on past content analysis of therapist behaviours during ICBT. Five therapists trialed this initial measure and provided feedback on their experiences during a focus group. The measure was then revised and inter-rater reliability was established between three student raters. The scale was used to examine emails that were sent to 50 patients who completed an 8-week transdiagnostic ICBT course for depression and anxiety (Wellbeing Course).

Results: Review of ratings suggested that most therapists were providing high quality emails. Multiple significant correlations were found which indicated that clients who sent more emails to their therapist were receiving better quality emails, that therapists who were solely focused on delivering ICBT, and therapists with a psychology background obtained higher ratings on the scale.

Practical Implications: Numerous directions for future research exist, such as exploring the applicability of the scale to other ICBT units.

Development and initial evaluation of a psychoeducational resource to facilitate social support for cancer survivors

Honours Thesis Results, Chantalle Fuchs 2014

Most cancer survivors appear to adjust well to having a cancer diagnosis over time, but research has shown that some cancer survivors experience clinical levels of anxiety and depression. In addition, it has been shown that social support often decreases after cancer treatment.

Wellbeing After Cancer (WAC) is an online cognitive behavioural therapy program designed to treat anxiety and depression among cancer survivors. Feedback from program participants suggested that information and strategies regarding social support would be beneficial.

To date, no known online educational resource has been developed to address social support among cancer survivors and family members. The objectives of the study were to:

1. Develop a supplementary psychoeducational resource focused on social support to accompany the WAC online program. Information discussed on the resource included fatigue, concentration and memory changes, pain, swelling, nervous system changes, low moods, anxious feelings, worries about cancer returning, feeling alone, benefits of social support, communication strategies, styles of communication, and sources of support.
2. Conduct a preliminary evaluation of this resource. Assessing the face-validity of this resource is an important first step in adding educational materials to online programs like WAC.

Survivors and family members reviewed the resource, rated different sections within the document, and responded to open-ended questions pertaining to the acceptability and helpfulness of the resource. Participants indicated that the resource was informative, applied to their personal relationships, enhance their understanding of what can occur after completing cancer treatment, and that the suggestions listed within the resource were feasible. All individual sections within the resource were deemed informative as well as accurate.

The open-ended responses revealed areas for improvement such as integrating more specific examples and information on additional challenges faced by survivors. Additional challenges described by cancer survivors included feelings of anger and frustration, difficulties with eating, as well as sexual and intimate concerns.