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.

Chantalle Fuchs

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.

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.