Vanessa Peynenburg

Examining motivational interviewing and booster sessions in Internet-delivered cognitive behaviour therapy for post-secondary students: An implementation trial

PhD Thesis Results, Vanessa Peynenburg 2022

Background: Nearly one-third of post-secondary students meet criteria for a mental disorder within any given year, with many students not receiving treatment. Internet-delivered cognitive behaviour therapy (ICBT) is an alternative to face-to-face services that is effective in general adult populations, but has been associated with high attrition rates and smaller effect sizes in student populations. Motivational interviewing (MI) is used by therapists in face-to-face settings and can help improve treatment completion and outcomes. Booster sessions are often used in face-to-face therapy to maintain long-term changes. To date, the use of online MI and booster sessions in ICBT for students has not been examined. In this implementation trial, the role of MI and booster sessions on treatment completion and outcomes was examined in Saskatchewan.

Methods: In this factorial trial (factor 1: presence of pre-treatment online MI); factor 2: presence of a booster lesson), a total of 308 clients were randomized to one of four groups: standard care, MI, booster, and MI + booster. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing Course) for symptoms of depression and anxiety. Primary outcomes included symptoms of depression, anxiety, and perceived academic functioning. All primary measures were administered at pre-treatment, post-treatment, and 1- and 3-month follow-up, Implementation outcomes (i.e., acceptability, adoption, and fidelity) were also examined.

Results:  Across all four groups, clients experienced large reductions in symptoms of depression and anxiety, as well as small improvements in perceived academic functioning. Changes were maintained at 1-month and 3-month follow-up. No benefit was found for the inclusion of MI on treatment completion, although clients who were assigned to MI had slightly larger improvements in symptoms of depression and anxiety at post-treatment. 30.9% of client assigned to one of the booster groups accessed the booster. When examining the booster groups as a whole, no benefits were found for improvements in depression, anxiety, or perceived academic functioning at 3-month follow-up. However, a sub-analysis of clients who accessed the booster found a small advantage in favour of the booster for depression. Overall, clients were satisfied with ICBT, although treatment completion remained low. Uptake of the ICBT course was highest at the two largest post-secondary institutions in Saskatchewan.

Conclusions: There is some evidence to suggest that including MI at pre-treatment results in greater symptom reduction, although these benefits do not persist to 1-month and 3-month follow-up. The inclusion of a self-guided booster lesson may also help with continued symptom management up to 3-month follow-up, but low uptake is a barrier to clients experiencing these benefits. Findings from this trial contribute to the literature on improving ICBT outcomes for post-secondary students.

Perceptions of and preferences for Internet-delivered cognitive behaviour therapy for anxiety and depression in post-secondary students

Masters Thesis Results, Vanessa Peynenburg 2019

Background: Anxiety and depression are prevalent mental health concerns experienced by post-secondary students. Rates of help-seeking are often low in this population, and students face several barriers to accessing psychological treatment. Internet-delivered cognitive behaviour therapy (ICBT) is an effective alternative to face-to-face therapy that addresses these barriers in adult populations with some evidence showing ICBT can also be effective with students. Additional research is necessary to identify students perceptions of and preferences for ICBT to assist with future implementation efforts in student populations. 

Methods: 314 Canadian post-secondary students completed an online survey and completed questionnaires about their symptoms of depression, anxiety, alcohol and drug use, and medical service utilization over the last 12 months. Students rated the acceptability and credibility of three treatment options (ICBT, face-to-face therapy, and medication) for the treatment of anxiety and depression. They also rated the utility of different kinds of content to be included in an ICBT course. 

Results: The three treatment options were rated as moderately acceptable and credible. Students expressed a preference for face-to-face services (44.6%), followed by medication (31.9%), and finally ICBT (23.5%). ICBT became more preferable once students would have to wait to receive face-to-face therapy. Students who were female and had less severe symptoms of depression had more positive perceptions of the use of ICBT in the treatment of anxiety and depression.

Conclusions: While many students expressed a preference for face-to-face therapy or medication over ICBT, a substantial number preferred ICBT. Students often have to wait to receive face-to-face therapy, so ICBT may also be more desirable in these circumstances. Implementation trials in student populations are necessary to identify barriers to implementation efforts.

Nichole Faller

A Randomized Controlled Trial of an Online Psychoeducation Course for Improving Knowledge and Access to Mental Health Accommodations

Doctoral Dissertation, Nichole Faller, 2021

Background: Available research on mental health accommodations within the workplace  suggests that employees with mental health concerns require  accommodations to improve work functioning. Unfortunately, only a  fraction of employees requiring mental health accommodations will  receive the accommodations they have requested. Reported barriers to  receiving mental health accommodations include lack of knowledge about  appropriate accommodations, concerns regarding stigma, and financial  constraints of the employer. There is a paucity of research available on  interventions aimed at improving accommodation knowledge and usage for  mental health concerns.

Method: The primary goal of the current study was to assess the efficacy of a  four-lesson, online, psychoeducational course developed to provide  information on anxiety/depression symptoms in the workplace, appropriate  accommodations to help manage symptoms, considerations for disclosure  of a mental health concern and accommodation requests, and general tips  for symptom management. A total of 89 participants with  anxiety/depression symptoms that were negatively impacting work  functioning were randomly assigned to a treatment group that received  access to the Workplace Coping Strategies (WCS) course or an eight-week  waiting list group. All participants received questionnaires at four-  and eight-weeks post randomization. Primary outcomes of interest  included the impact of the WCS course on requesting/receiving  accommodations, employee knowledge of accommodations, self-stigmatizing  attitudes, and workplace relationships. Organizational inclusivity and  supervisory leadership were also examined to determine how these  variables impacted accommodation usage and disclosure rates. Secondary  outcomes assessed the efficacy of the WCS course on comfort levels  disclosing and rates of disclosure. Exploratory analyses examined the  impact of the WCS course on absenteeism/presenteeism scores,  self-efficacy, and symptomology. Finally, quantitative content analyses  were used to examine qualitative data on accommodations identified,  barriers/facilitators to requesting/receiving accommodations, and  participant feedback on the course.

Results: Results suggest that those who participated in the WCS course relative  to the waiting list group had large improvements in accommodations  knowledge, increased self-efficacy, and improved presenteeism scores.  Both groups reported reduced internalized mental health stereotypes and  increased disclosures of mental health concerns over time. Regression  analyses further demonstrated that partial disclosures were associated  with organizational inclusiveness and supervisory leadership. The  results suggest that the intervention did not have an impact on  accommodation usage, symptomology, workplace relationships, or comfort  level disclosing a mental health concern. Qualitative analyses showed  that participants most frequently identified accommodations related to  scheduling flexibility and job description modification with limited  mention of communication facilitations and/or modifications to physical  space. The most frequently cited barrier was poor relationships with  management, while supportive relationships were considered a facilitator  for requesting/receiving an accommodation. Participants reported liking  the clarity and conciseness of the course content the most and disliked  aspects of the  course structure, such as a lack of video options. Areas  for improvements included changes to questionnaires (e.g., less  frequent), addition of employer-centered material (e.g., tips for  discussing mental health), and the use of persuasive design to increase  engagement.

Conclusions: Participants were satisfied with this treatment modality and were able to establish a strong working alliance with their online therapist. Results from the current study provide emerging evidence for transdiagnostic ICBT in the treatment of postpartum anxiety and depression.

Victoria Suchan

Examining the acceptability and effectiveness of transdiagnostic, Internet-delivered cognitive behaviour therapy for symptoms of postpartum anxiety and depression: A randomized controlled trial

Doctoral Dissertation, Victoria Suchan, 2021

Background: Following childbirth, women experience significant biological, physical, social, and emotional changes, wherein 20% of new mothers experience clinically impairing symptoms of anxiety or depression. Although effective treatment options exist, such as cognitive behaviour therapy (CBT), new mothers report barriers to accessing such services. Importantly, many of these barriers can be overcome using Internet-delivered CBT (ICBT), which has been found to be effective in the treatment of various mental health concerns, including depression and anxiety. As postpartum anxiety and depression often co-occur, transdiagnostic ICBT that addresses both

Method: The current study explored the acceptability and effectiveness of a transdiagnostic ICBT program, the Wellbeing Course for New Moms, with a sample of Saskatchewan women who had an infant less than one year of age. Participants (= 60) endorsing symptoms of depression or anxiety were randomly assigned to the Wellbeing Course for New Moms or a waitlist control (WLC) group. Participants completed measures pre-treatment, post-treatment, and 1-month follow-up. Treatment satisfaction, therapeutic alliance, and open-ended questions assessing participant experiences with treatment were also explored.

Results: The analyses revealed that both treatment and WLC participants experienced significant reductions in anxiety, depression, and distress over time, as well as improvements in mother-infant bonding.  The treatment group reported significantly superior improvements in symptoms of anxiety and distress as compared to the WLC. For the treatment group large changes were seen on measures of anxiety and depression and symptom improvement was maintained at follow-up. On some measures of depression, however, differences between the WLC and the treatment group not statistically significant, although trends were observed.

Conclusions: Participants were satisfied with this treatment modality and were able to establish a strong working alliance with their online therapist. Results from the current study provide emerging evidence for transdiagnostic ICBT in the treatment of postpartum anxiety and depression.

Increasing favourable expectations of therapist-assisted Internet-delivered cognitive behaviour therapy: Importance of testimonial-based versus statistically-based information

Masters Thesis Results, Victoria Owens 2017

The current study explored whether transdiagnostic, Internet-delivered cognitive behaviour therapy (ICBT) is effective in the treatment of health anxiety, characterized by excessive worry about one’s health and fear that one will acquire an illness. Further, the level of therapist support, namely weekly therapist support or optional therapist support, was examined. Ninety-six clients participating in the Wellbeing Course, an 8-week transdiagnostic ICBT program, with elevated health anxiety symptomatology (≥15 on the Short Health Anxiety Inventory [SHAI]) were included in the current study. Results suggest that health anxiety symptoms significantly reduce following transdiagnostic ICBT. Additionally, clients receiving both weekly and optional therapist contact experienced symptom reduction to a similar extent; however, clients that received weekly therapist contact displayed more favourable treatment engagement (i.e., more lessons completed, more messages sent). Future research is warranted to disentangle the role of therapist contact on symptom reduction and treatment engagement. The results from the current study lend support for the use of transdiagnostic ICBT in the treatment of health anxiety.

Increasing favourable expectations of therapist-assisted Internet-delivered cognitive behaviour therapy: Importance of testimonial-based versus statistically-based information

Honours Thesis Results, Victoria Owens 2015

Background: Internet-delivered Cognitive Behaviour Therapy (ICBT) is an effective method of treating anxiety and depression. Nevertheless, many individuals have low expectations about this treatment given that it is novel. This presents a problem, as higher expectations of treatment have been linked to more favourable treatment outcomes.

Objective: The aim of the present study was to determine if an educational video about ICBT is an effective way to increase individuals’ views of this treatment.

Methods: Participants were assigned to view an educational video about ICBT containing testimonial-based (n = 44) or statistically-based information (n = 53). Questionnaires administered pre- and post-video were analyzed to assess for changes in attitudes towards ICBT, and to determine whether one video was more effective. Correlates between participant characteristics and views of ICBT were examined.

Results: Perceptions of ICBT significantly improved post-video; however, the difference between the two video conditions was not significant. While participant characteristics (e.g., age, sex) were not correlated with views of ICBT, how participants rated the video were.

Conclusion: Educational videos effectively increase expectations of ICBT, and the quality of information presented in the video is more important than the particular information presented.

Practice Implications: In order to facilitate the greatest therapeutic benefit from an ICBT treatment program, it may be beneficial for clients to watch an educational video prior to the onset of treatment.

Joelle Soucy

Online motivational interviewing for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial

Doctoral Dissertation Results, Joelle Soucy 2020

Background: Despite the fact that internet-delivered cognitive behaviour therapy (iCBT) can be used to effectively reduce symptoms of anxiety and depression, not all clients benefit from treatment. Opportunities exist to further enhance treatment outcomes in order to maximize the impact of iCBT. Motivational Interviewing (MI) is a clinical tool used by therapists to help facilitate clients’ motivation to change. Integrating MI and face-to-face therapy in the treatment of anxiety has been shown to result in better treatment response and completion relative to face-to-face therapy alone. Therefore, there is a possibility that combining iCBT with online MI can result in similar outcomes. This investigation sought to first develop a brief, interactive online MI pre-treatment that was designed to increase motivation to engage in iCBT for anxiety and depression. Once the protocol was developed and piloted, we examined the impact of the online MI pre-treatment on motivation levels, symptom change, and treatment engagement/completion.

Methods: A total of 480 clients applying to iCBT were randomly assigned to first receive the MI pre-treatment or no pre-treatment. The online MI pre-treatment consisted of a single lesson that comprised of videos, exercises, and feedback designed to increase intrinsic motivation to engage in iCBT. All clients then participated in an 8-week transdiagnostic iCBT program for anxiety and/or depression that consisted of 5 lessons aimed at providing psychoeducation and coping techniques for managing symptoms of anxiety and depression.    

Results: Contrary to prediction, little evidence of using online MI to further improve iCBT outcomes for anxiety and depression was found in the study. Engagement in iCBT was high across groups, with clients completing the same number of lessons and logging into the program a comparable number of times. Clients in both groups also reported high levels of motivation both prior to and following the MI period. Similarly, across groups, clients reported large reductions in anxiety and depression from pre- to post-treatment. During the 6-month follow-up, cliens in the iCBT only group continued to report small reductions in symptoms of anxiety, whereas clients in the MI plus iCBT group did not continue making improvements. The addition of MI to iCBT was also associated with minor increases in symptoms of depression during follow-up, wheras symptom improvements were maintained for clients in the iCBT only group.

Conclusions: Results from this study suggest that online MI may not enhance client outcomes when motivation at pre-treatment is high. In some instances, online MI may also prevent further treatment progress, especially among individuals with high motivation to engage in treatment. Moving forward, it will be important to determine if specific client populations benefit more from online MI.

Treatment acceptability and preference among primary care patients experiencing severe health anxiety: The role of internet-delivered cognitive behaviour therapy

Masters Thesis Results, Joelle Soucy 2016

Although cognitive behaviour therapy (CBT) is a helpful intervention for health anxiety, many individuals are unable to receive this treatment because of difficulties accessing it. Internet-delivered cognitive behaviour therapy (ICBT) is a new and accessible treatment that has been shown to successfully manage symptoms of health anxiety; however, it remains unclear whether ICBT would be used if in fact offered to individuals with health anxiety. The goal of this study was to see how patients perceive ICBT compared to other existing treatments for health anxiety. Primary care patients who were experiencing symptoms of health anxiety were presented with descriptions of three different treatments for health anxiety. The treatments were medication, CBT, and ICBT. Perceptions of the treatments were assessed following the presentation of each treatment description. Participants were also asked to rank the three treatments based on the likelihood wanting to receive that intervention for health anxiety. Results indicated that all three treatments were similarly rated as moderately acceptable. The highest preference ranks were for CBT and medication. That said, a small sample of participants ranked ICBT as the preferred intervention. While CBT and medication were the preferred treatments for health anxiety, the generally favourable perceptions of ICBT found in the study suggest that it would likely be considered a desirable treatment option by a number of potential users.

Luke Schneider

Efficacy of Internet-delivered cognitive behavioural therapy following an acute coronary event: A randomized controlled trial

Doctoral Dissertation Results, Luke Schneider 2019

Depression and anxiety are common after a heart attack or other acute cardiac event, however, evidence-based mental health interventions are not routinely available in cardiac rehabilitation programs. The focus of this study was to explore the effectiveness and acceptability of the Cardiac Wellbeing Course: an Internet-delivered cognitive behavioural therapy program to help survivors of cardiac events manage depression and anxiety.

The Cardiac Wellbeing Course was offered between August 2016 to April 2018 to Canadians who recently experienced a cardiac event (heart attack or unstable angina) in the last two years. A total of 25 participants were enrolled in the course and their levels of depression, anxiety, physical activity, and quality of life were compared to 28 participants who did not receive the course.

Results of the study were favourable, such that large and statistically significant improvements in depression and anxiety were observed among participants who received the course. A rise in physical activity levels and quality of life was also observed among participants who received the course. Satisfaction with the course was high and a majority of participants (92%) completed the course.

The results of this study highlight the potential of the Cardiac Wellbeing Course to help people who have experienced an acute cardiac event to manage depression and anxiety. Future research should look at evaluating the Cardiac Wellbeing Course in a larger sample, preferably in a cardiac rehabilitation setting.

Initial perceptions of Internet-based cognitive-behaviour therapy for chronic pain among potential users: Examining interest, perceived barriers, and strengths

Masters Thesis Results, Luke Schneider 2013

Background:

Chronic pain is an important area of study given that 15 to 18% of the Canadian population will develop a chronic pain condition during their lifetime. One difficulty in the self-management of chronic pain is the lack of resources available for those who suffer from this condition. Although preliminary research has demonstrated Internet Cognitive Behaviour Therapy (ICBT) for chronic pain to be a viable treatment option, potential users’ initial perceptions towards this mode of delivery may pose a barrier for participation in such programs. The purpose of the study was threefold:

  1. To develop an ICBT perceptions questionnaire (ICBT-PQ) that captures the perceptions of potential users of the service
  2. To examine variables that may predict early perceptions of ICBT (e.g., age, sex, computer self-efficacy)
  3. To identify perceptions of what intervention features would be perceived by potential users as most desirable for ICBT

Methods:

Given the steps necessary to address the research questions, the overall project was divided into two studies. In study one, the ICBT-PQ was developed based on a comprehensive review of the literature and telephone interviews with 11 participants who had chronic pain. The preliminary version of the ICBT-PQ was then reviewed by researchers with ICBT experience and by a lay audience to ensure readability and acceptability.

In study two, a total of 129 people with chronic pain completed a web-based survey consisting of a demographic questionnaire, the finalized ICBT-PQ, and measures of computer self-efficacy and computer anxiety. Participants were predominantly female (82%), Caucasian (90%), middle-aged (average age = 47), and had chronic pain for an average of 12 years.

Results:

Through the factor analysis, the ICBT-PQ items were grouped into two categories: statements of potential ICBT strengtdhs and statements of potential ICBT limitations.

The majority of participants endorsed ICBT strength statements and disagreed with ICBT limitation statements.

ICBT strength statements that participants most agreed withICBT limitation statements that participants most disagreed with
“ICBT is important for patients who have difficulty moving or getting around”
“ICBT is important for patients who have a hard time attending appointments for various reasons”
“ICBT is important for patients who live in rural areas”
“People with a high school education could use ICBT”
“If I used ICBT I would worry about the security of my personal information”
“If I used ICBT I would worry about getting a computer virus”
“ICBT is not necessary because there is already enough information available on chronic pain management on the Internet”
“If I used ICBT I would worry about making a mistake using the computer”
“Patients don’t really need extra information on how to manage chronic pain”

Conclusion:

Even though participants had no prior experience with ICBT, they generally had positive perceptions of ICBT such as accessibility and convenience. They did not perceive ICBT to have many negative limitations, such as computer concerns or concerns about the security of their personal information. The perceived strengths of ICBT outweighed the perceived limitations among study participants, which may indicate that ICBT may be well received if offered to Canadians with chronic pain.

Female participants and those with high computer self-efficacy were more likely to perceive ICBT favorably. Participants felt that it would be positive to include multimedia and group contact features in the ICBT program. Future research, however, needs to investigate whether these features are necessary and or improve the efficacy of ICBT.

Overall, the results of this study provide important information that could assist with future attempts to deliver ICBT to people with chronic pain.

Thank you to everyone for their participation in this research. The reserch findings have been submitted and accepted for publication in the academic journal Pain Research and Management.

Dale Dirkse

A randomized trial of technician-guided and self-guided ICBT: Wellbeing After Cancer

Doctoral Dissertation Results, Dale Dirkse 2018

Internet-delivered  cognitive behviour therapy (ICBT) has only recently been used to treat  anxiety and depression within a cancer population but has demonstrated  promising results. The focus of this study was to assess the  effectiveness of two forms of non-therapist assisted ICBT for cancer  survivors with symptoms of depression and anxiety in a larger sample.  The Wellbeing After Cancer course was offered to Canadians from August 2016 to May 2017. In this study we were interested in the impact of Wellbeing After Cancer on symptoms of depression, anxiety, fear of cancer recurrence, and overall quality of life after the course.

Wellbeing After Cancer included education about depression and anxiety, strategies to identify  and modify unhelpful thoughts, manage physical symptoms of anxiety and  depression, overcome avoidance, cope with uncertainty, and maintain  improvements after treatment. The course was administered to a  randomized group of cancer survivors; 42 individuals who were guided by a  technician and 44 individuals who independently progressed through the  course.

The findings were very encouraging. The results of this  study showed that participants’ symptoms of anxiety and depression  improved significantly from pre to post treatment. Participants also  reported strong satisfaction ratings with the program.  Furthermore,  there was no difference in anxiety or depression symptom improvement or  overall satisfaction between those who were guided by a technician or  those who independently progressed through the course. Participants also  improved on secondary measures of fear of cancer recurrence and quality  of life.

Results from this study demonstrate the ability to  provide effective treatment to Canadian cancer survivors with symptoms  of anxiety and depression from one centralized site.  Providing ICBT has  the potential to change the mental health care landscape for cancer  survivors across Canada. Future research should focus on best practices  for implementation of ICBT. 

Linguistic analysis of communication in a therapist-assisted Internet-based cognitive behaviour therapy program for individuals with generalized anxiety disorder

Masters Thesis Results, Dale Dirkse 2014

Background: Therapist-assisted Internet-based Cognitive Behaviour Therapy (TAICBT) is an effective method of treating generalized anxiety disorder (GAD). In addition to the cognitive and behavioural elements found within face-to-face Cognitive Behaviour Therapy (CBT), TAICBT includes elements of expressive writing, through email communication with a therapist. Expressive writing has been associated with positive outcomes; furthermore, certain linguistic dimensions have been associated with psychological and physical health benefits.

Objective: The purpose of the present study was to understand how clients with symptoms of GAD are communicating with their online therapists, and explore whether their communication style was related to successful participation.

Method: Written communication submitted to therapists by 107 adult clients with symptoms of GAD during the course of a 12 module TAICBT program was analyzed along with symptom measures of anxiety, worry, and adjustment. Clients’ written communication was analyzed by a linguistic software (Linguistic Inquiry and Word Count Software) which categories words into several categories (e.g., negative emotion words, insight words).

Results: Negative emotion words, anxiety words, insight words, and past tense words were associated with symptom measures of anxiety and worry and they changed over time. A higher number of negative emotion and anxiety words differentiated clients that dropped out of the program earlier versus those that dropped later, and were associated with reduced therapeutic alliance and treatment satisfaction.

Discussion: Results suggest it may be useful to pay attention to linguistic categories as they can be used as indicators of client progress and well-being. Findings improve our understanding of the client experience of participating in TAICBT, with some linguistic trends being consistent with what clinicians would expect to see from a client’s successful participation in therapy. Other findings offer new insight into communication that may be particularly relevant to clients with symptoms of GAD. Findings confirm that clients are engaging with the program and opening up to their therapists.

Christina Drost

Examination of therapist behaviours in therapist-assisted Internet-delivered cognitive behavioural therapy for generalized anxiety disorder

Doctoral Dissertation Results,Christina Drost 2016

Background: Therapist-Assisted Internet-Delivered Cognitive Behavioural Therapy (TAICBT) for the treatment of generalized anxiety disorder (GAD) is found to be efficacious. The nature of therapist-assistance, however, is not well understood. This research aimed to enhance understanding of the nature of therapist-assistance by examining: 1) therapist behaviours in emails sent to clients treated with TAICBT for GAD and the extent to which these qualitatively overlap with behaviours described in face-to-face therapy; and 2) if therapist behaviours in the current study (using a larger and more diverse therapist sample) compared to therapist behaviours reported in a past study of TAICBT for GAD (Paxling et al., 2013). The relationship between therapist behaviours and treatment outcome, treatment satisfaction, and therapeutic alliance was also examined.

Method: Data was collected as part of an open trial investigating a 12 module TAICBT program delivered to 107 clients presenting with symptoms of GAD. TAICBT was provided by 21 registered therapists or 31 graduate students; therapist-assistance was delivered through secure e-mails. Anxiety was assessed before and after treatment. 

Results: Nineteen therapist behaviours were identified in the secure messages sent from therapist to patients. These behaviours qualitatively overlapped with therapist behaviours that are commonly observed in face-to-face therapy. Alliance Bolstering was the most frequently coded therapist behaviour. Eight therapist behaviours were found that largely overlapped with behaviours reported in a past study of therapist behaviour in TAICBT (Paxling et al. 2013); however, the frequency of these behaviours varied substantially between studies. Correlational analyses suggested that therapists provided more frequent feedback on weekly mood ratings and self-report questionnaires when clients demonstrated less improvement on anxiety measures. Analyses also suggested that therapists were more likely to provide Psychoeducation and Task Prompting when clients demonstrated less improvement on anxiety. Of note, Repair of Potential Alliance Ruptures was significantly and positively associated with higher client ratings of therapeutic alliance. Therapist e-mails received during the first two modules by treatment completers contained significantly more instances of statements coded as Course Procedure and Goal Setting than e-mails received during the first two modules by treatment non-completers. 

Conclusions: Overall, preliminary evidence was found to suggest that: 1) there is both overlap and variability in terms of therapist-assistance provided in face-to-face therapy and across different TAICBT programs, and 2) the relationship between therapist behaviours, treatment outcome, therapeutic alliance, and treatment satisfaction is complex and needs to be examined further. The findings shed substantial light on the nature of therapist-assistance in TAICBT.

Lindsay Friesen

A randomized controlled trial of Internet-delivered cognitive behaviour therapy for individuals with fibromyalgia

Doctoral Dissertation Results, Lindsay Friesen 2015

The focus of this study was to assess the efficacy of Internet-delivered cognitive behaviour therapy (ICBT) for individuals with fibromyalgia (FM) who experience difficulties with pain, depression and or anxiety.  The Pain Course for Fibromyalgia was offered to Canadians from January 2014 to January 2015.  In this study, we were interested in the impact of the Pain Course for Fibromyalgia on FM symptoms, pain, depression and/or anxiety, and improving overall quality of life after the course.

The Pain Course for Fibromyalgia included topics of symptom identification, examining and challenging unhelpful thoughts, controlled breathing, pleasant activity scheduling, pacing, graded exposure, and relapse prevention. The course was administered to a randomized group of 30 individuals with FM and compared to a group of 30 individuals with FM who received standard care alone.

The findings were very encouraging.  The results of this study showed that symptoms of FM, anxiety, and depression improved significantly from pre to post treatment.  Participants also rated the course as highly acceptable and identified several course strengths.

Results from this study indicate to health professionals that ICBT is a viable avenue to improve the clinical management and the health status of individuals with FM.

Nicole Alberts

Transdiagnostic Internet-delivered cognitive-behaviour therapy for recent cancer survivors: A feasibility trial and examination of clinician perspectives

Doctoral Dissertation Results, Nicole Alberts 2014

This dissertation involved two studies. In Study 1, Wellbeing After Cancer was made available to cancer survivors in Saskatchewan from February 2013 to May 2014. The therapist-guided Internet delivered cognitive behaviour therapy (ICBT) program was based on the Wellbeing Course, which is a transdiagnotic ICBT program developed and tested by the eCentre Clinic in Australia. The Wellbeing Course was modified for recent cancer survivors who experience anxiety and/or depression. Eighteen individuals who completed primary cancer treatment within the past 18 months received CBT-based online lessons, homework assignments, once weekly contact from a therapist via e-mail or phone, and automated emails. Results of Study 1 showed that symptoms of anxiety and depression improved significantly from pre to post treatment. Participants also rated the program as highly acceptable and identified several program strengths.

Study 2 examined the acceptability of Wellbeing After Cancer and ICBT more generally among clinicians currently working within cancer care in Saskatchewan. Ten clinicians viewed a brief online video and completed a telephone interview regarding their perceptions of the program. ICBT and the program were viewed as acceptable by clinicians, with most envisioning themselves referring clients to the program. Several program strengths as well as areas for improvement were identified. Approval from directors as well as clinician availability and time were seen as factors likely to influence training, delivery, and implementation.

Together, the results of both studies indicate to researchers, clinicians, and healthcare providers that ICBT is a viable avenue for offering mental health services to cancer survivors.

Nicole Pugh

Maternal Depression Online: A preliminary study

Doctoral Dissertation Results, Nicole Pugh 2014

Maternal Depression Online (MDO) was made available to Saskatchewan women from May 2012-Feburary 2014. The therapist-assisted Internet delivered Cognitive Behaviour Therapy program was designed specifically for the treatment of postpartum depression. MDO consisted of 7 interactive modules including text, graphics, animation, audio and video, and covered:(a) psychoeducation on maternal depression, (b) activity planning, (c) relaxation, (d) thinking styles, (e) cognitive restructuring, (f) problem solving, and (g) relapse prevention. Using a randomized control design, 50 women with mild to moderate postpartum depression either received MDO or waited for treatment.

Results were very promising. Symptoms of postpartum depression decreased more quickly for women participating in MDO when compared to those who waited for treatment. These results were maintained at four-week follow-up, providing preliminary support of the durability of the program. Participants who received MDO also demonstrated a reduction in symptoms of postnatal anxiety, general stress, and parental distress and an increase in quality of life when compared to participants who waited for the treatment. Participants reported high satisfaction with MDO and indicated that they enjoyed working with their Internet therapist. Discussion for future implementation of this program is underway.